How Healthcare Works in Spain

Who this is for

Key tradeoffs

Important considerations that affect most people in this situation.

The public healthcare system (SNS)

Spain's Sistema Nacional de Salud (SNS) provides universal coverage to eligible residents. The quality is genuinely good—Spain consistently ranks high in European healthcare comparisons. The main friction is access speed, not care quality.

• Primary care happens at local health centers (Centro de Atención Primaria or CAP). You're assigned to one based on your registered address
• You get an assigned GP (médico de cabecera) who becomes your first point of contact for everything
• Specialist care requires a GP referral in most cases. This is where wait times build up—seeing a specialist can take weeks to months
• Prescription medications are subsidized. Working people typically pay 40-50% of medication costs; retirees and low-income individuals pay less
• Emergency care (urgencias) is available to everyone regardless of registration status—this is important for the arrival gap period

Registering for public healthcare

Each autonomous community manages its own health service, so exact steps vary by region. The general sequence is consistent though.

• First: complete empadronamiento at your local town hall. This is the gating step that unlocks healthcare registration
• Have your NIE or residence permit ready. Some regions accept the NIE assignment letter before you have the physical card
• Visit your local CAP or regional health service office with passport, NIE, empadronamiento certificate, and Social Security affiliation proof (if employed)
• You'll receive a health card (tarjeta sanitaria). Processing takes anywhere from same-day to several weeks depending on region—Catalonia and Madrid tend to be slower
• Once registered, you can book GP appointments. First-time appointments typically available within a few days

Private healthcare options

Private healthcare in Spain is well-developed and widely used. The practical difference from public: speed of access and language convenience.

• Major insurers (Sanitas, Adeslas, DKV, Asisa, Mapfre) have extensive networks. Coverage quality is broadly similar; the differences are in specific hospital networks and price points
• Many expats use a hybrid approach: private for routine care and convenience, public for serious conditions where cost could escalate significantly
• Private insurance is mandatory for certain visas (non-lucrative, student, digital nomad). The insurance must meet specific requirements—not all policies qualify
• Employer-provided private insurance is common in Spain, especially in professional and tech roles. This often solves the coverage question entirely
• Paying out-of-pocket for private care is possible. GP visits run €50-100; specialists €80-150. Fine for occasional use; unsustainable for ongoing treatment

Practical realities

These factors shape the day-to-day experience of healthcare in Spain.

• Language — English proficiency among doctors varies widely. In Barcelona and Madrid, finding English-speaking doctors (especially in private practice) is straightforward. Smaller cities, much less so
• Wait times — the practical difference between public and private. Public specialist appointments: 2-8 weeks typical. Private: often within days. For urgent issues, both systems move quickly
• Regional variation — healthcare is managed regionally, and quality genuinely differs. Catalonia, Madrid, and the Basque Country generally have the strongest systems
• Medication continuity — if you take ongoing medications, bring documentation from your home country. Spanish doctors can usually continue prescriptions but need to see your history
• Emergencies — dial 112. Hospital emergency rooms don't require registration or insurance verification. Treatment happens first; paperwork later

Next steps

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