Spain is a great place to visit and to live! Nestled between Portugal and France in Southwestern Europe, Spain is both geographically and culturally diverse. It’s a storied country of stone castles, snow-capped mountains, vast monuments, and sophisticated cities. It’s hard to top the food, markets, and architecture of this beautiful country.
If you’re planning to visit or move to Spain, it’s important to become familiar with their healthcare system. The Spanish Constitution guarantees all citizens the “right” to healthcare – including equal access to preventative, curative, and rehabilitative services.
Coverage under the Spanish system is nearly universal, estimated at 98.7% of the population. However, you should be aware that a law was modified in 2013 to make many healthcare services unavailable to expats.
Regional Healthcare in Spain
Spain’s National Healthcare System was founded on the Healthcare Act of 1986,
and was decentralized in 2002 to provide better healthcare access to its population. This decentralization has improved healthcare technology and response time.
Responsibility for administering healthcare was delegated to the country’s 17 regions. The federal government provides each region with a block grant. The money is not earmarked; the region decides how to use it. There is limited coordination between the regions, so there are many disparities in the services and quality of care between the regions.
Healthcare Cost to Citizens
Spain’s public healthcare system is funded by social security payments from employed and self-employed workers. Taxes in Spain are higher than most other countries, including the U.S.
However, the system doesn’t provide all healthcare for free. On average, out-of-pocket payments by patients are around 24% of the total cost, which is higher than most other European countries.
Patients are responsible for paying for pharmaceutical, orthotic, prosthetic, and other health products. They may pay anywhere between 10 and 60 percent of the full price, depending on their income level.
Patients needing specialized medical care may face additional costs, so private medical insurance is often purchased. The public healthcare system does not cover dental care or eyeglasses.
Are Patients Able to Choose Doctors?
Spanish patients cannot choose their physicians, either primary care or specialist. Rather, they are assigned a primary care doctor from a list of physicians in their community.
If more specialized care is needed, the primary care physician refers patients to a network of specialists. One may not go “out of network” unless the patient has private health insurance. This has sparked an interesting phenomenon where sick Spaniards move to change physicians or find networks with a shorter waiting list.
Long Wait Times for Care
Waiting lists vary from region to region but are a significant problem everywhere. On average, Spaniards wait 65 days to see a specialist, 71 days to wait for a gynecologist, and 81 days for a neurologist. The mean waiting time for a proctectomy is 62 days and for hip replacement surgery is 123 days.
Some health services that US citizens take for granted are almost totally unavailable. For example, rehabilitation, convalescence, and care for those with terminal illness are usually left to the patient’s relatives.
There are few public nursing and retirement homes, and few hospices and convalescence homes. Most long-term caregiving is also left to the patient’s relatives.
Health Technology Shortages
There are also shortages of modern medical technologies. Spain has one-third as many MRI units per million people as the US and just over one-third as many CT units, and fewer lithotripters. Some regions, like Ceuta and Melilla do not have a single MRI unit.
All hospital-based physicians and approximately 75% of all other physicians are considered quasi-civil servants. They are paid a salary rather than receiving payment based on services provided. As a result, Spain has fewer physicians and fewer nurses per capita than most European countries and the US.
Mental Healthcare in Spain
Mental healthcare provisions in Spain fall short. The number of per capita clinical psychologists is less than 20% of the EU average number. And less than 10% of them work for the public health system.
In recent years, Spain launched a $100 million mental health plan that is in the process of being implemented. The plan focuses on training professionals, fighting stigmatization, preventing addiction and suicide, and promoting emotional well-being.
The Growth in Private Health Insurance
As with most other national health care systems, the waiting lists and quality problems have led to the development of a growing private insurance alternative. About 25% of the population have chosen private health insurance to get better and quicker access to treatment. In addition, citizens needing a dentist or mental healthcare professional are better off using private health insurance.
Overall, private insurance payments amount for 21% of total health care expenditures. More commonly, Spaniards pay for care outside of the national health care system out of pocket. In fact, nearly 24% of health care spending in Spain is out of pocket – more than any European country except Greece and Switzerland, and even more than the United States.
Here again, a two-tier system has developed, with the wealthy able to buy their way around the defects of the national health care system, and the poor consigned to substandard services.
Citizens Want Improvements to the Current System
Considering the inherent problems, Spaniards are generally happy with their healthcare system. Nearly 60% of their citizens describe their system as good, the second highest favorability rating in Europe. However, Spaniards do want more choice of doctors and hospitals, and they want the government to do a better job of dealing with the waiting lists.
Overall Health of Citizens in Spain
Spain has one of the highest life expectancies in the EU, with their heart disease rate among the lowest in the world. However, their rate of skin cancer is among the highest in the world, and their rate of AIDS is among the highest in Europe.
Spain has a relatively high rate of smokers, with 40% of Spaniards between age 17 and 24 being smokers. Tobacco consumption has fallen over the past two decades, but one in five adults still smoked daily in 2019.
In 2021, one in five Spanish residents suffered from a mental health disorder. Spain is the world’s largest consumer of anti-anxiety medication and the EU’s largest consumer of psychiatric or psychotropic medication.
Beginning in the 1970’s, Spaniards began having fewer children. By the turn of the 21st century, the total fertility rate was one of the lowest in Europe and well below the rate of replacement.
Some believe this lower birth rate is largely the result of high unemployment and steep housing costs. The number of Spaniards living in traditional households (married with children) also dropped.
In Case of Emergency in Spain
If you have a serious, life-threatening emergency, you can call 112, which is the pan-European emergency number. The use of this number is free of charge and the operator speaks various languages, including Spanish and English. Other useful healthcare resources in Spain include:
- Confederacion Salud Mental Espana – Confederation of Mental Health in Spain
- English Speaking Healthcare Association Spain – a non-profit organization listing English-speaking doctors and healthcare professionals in Spain
- Farmacias de Guardia – online directory of 24/7 pharmacies in Spain
- Ministry of Health – the official government website with information on Spanish healthcare, including a section on gender-based violence and domestic abuse
Travelers and Expats in Spain Need Medical Insurance
Spain offers a regional public health care system to its citizens that reduces their healthcare expenses. However, due to limitations in their health care system, about 25% of their citizens buy private insurance. Since visiting tourists and expats are not covered by Spain’s public health care system, they must also purchase their own private insurance.
If you’re traveling to Spain, be sure to purchase travel health insurance. If you’re moving to Spain for an extended period of time, you may want to purchase expat insurance. Good Neighbor Insurance brokerage firm provides private health insurance coverage in Spain for US and non US citizens via international health insurance plans like IMG, GeoBlue, Cigna, and other overseas health insurance companies.
Enjoy your next adventure to Spain!