Spain is often a popular option for expats looking to move within Europe. With easy access to the continent, warm weather, sandy beaches, a diverse cultural heritage and the widespread use of English as a second language in tourist hotspots, it's no wonder so many people choose to relocate there. In fact, according to the United Nations Department of Economic and Social Affairs, when records were taken in July 2015, there were 308,821 UK expats living in Spain, and 39,825 US expats.
If you are considering moving to Spain, here are 10 things you might want to know about the country's healthcare system before you arrive.
1. National healthcare service
Free public healthcare in Spain is available on the national healthcare service, or 'el Sistema Nacional de Salud' (SNS). The system is funded in part by social security payments, which are deducted from employees' salaries, and in part by the government. The SNS means that patients do not have to pay upfront costs for healthcare (apart from paying part of the fee for a prescription).
This service is available to anyone who is registered to work in Spain and who makes national insurance contributions. Retired expats, overseas students and the unemployed should also able to access public healthcare if they have been granted temporary or permanent residency.
Expats who are only staying in the country for a short time, could apply for a European Health Insurance Card (EHIC) which provides temporary access to certain types of healthcare. This is not a long-term solution and it does not replace travel insurance, or cover private healthcare costs. The card is only available to EU, EEA and Swiss citizens. It covers medical treatment expats may need during their visit if they're ill or have an accident. It also covers treatment for long-term (chronic) conditions and existing illnesses, and routine maternity care. The card is free to apply for and is valid for up to five years.
2. Visas and permits
Expats from the EU do not need a visa or work permit to live or work in Spain, so they can access public healthcare without restriction. It is not certain how this would change if a member state withdraws from the EU, but it is possible that expats might need to apply for a Blue Card (an EU-wide work permit that allows highly skilled non-EU citizens to work in Spain). Expats from non-EU countries like the US need to apply for a residence visa or work permit to live or work in Spain. To do so, they usually have to provide proof of adequate private health insurance and may also need to supply a medical certificate.
3. Private healthcare
Expats who are not eligible for public healthcare, or those who do not want to rely solely on the public system, can opt for private health insurance. Many overseas visitors prefer this, as waiting times in private facilities are usually shorter than in public facilities. For expats who cannot speak Spanish, private healthcare can often mean that they are able to request an English-speaking doctor. For expats from the US, proof of private health insurance is a requirement for a residence visa.
4. State insurance scheme
For those who are not eligible for state-funded healthcare, but have been registered on the census at a local town hall for a year, there is a state insurance scheme ('convenio especial') that they can apply for. The scheme offers patients access to public healthcare for a basic monthly fee. It was launched in 2013, and is administered by each region's authorities. The scheme is currently available in Canarias, Castile and León, Galicia, Madrid, Murcia, Valencia and Andalucía.
5. Pharmacies and medication
Pharmacies are common in Spain and can be found everywhere from small rural villages to large cities like Barcelona and Madrid. They are marked with a green cross sign outside. Spain's prescription service is fairly relaxed, so many medications that usually require a prescription are available over the counter, such as antibiotics and inhalers. Patients only pay a percentage of the cost of their prescription – if they earn less than EUR 18,000 per year, they pay 40 percent of the prescription cost; if they earn more than EUR 100,000, they pay 60 percent.
6. General doctors and specialists
It's possible for expats to visit a general practitioner (GP) - doctor - or go to a health center to receive primary care, although they will generally have to register with a doctor in advance. Patients usually book an appointment in advance, but some practices see patients on a "first come, first serve" basis. Most health centers have about six doctors available. It's not guaranteed that patients will be treated by the same doctor each time; however, patients can request this – especially if they are receiving ongoing treatment. They can also request a referral from their doctor if they want to see a specialist.
7. Going to hospital
Patients generally need a doctor's referral to be admitted to hospital, except in an emergency. Depending on their health cover, they can either go to a public or a private hospital (both of which are widely available in Spain). Showing a social security card or proof of private health insurance will ensure that no unexpected charges are encountered for hospital treatment. In larger hospitals and in cities, doctors may speak English, though nurses and other hospital staff might not. Some hospitals have translators available to help, so it might be worth asking your local hospital before you arrive.
8. Standard of care
The standard of care in Spain's medical facilities (both public and private) is generally good. The healthcare system is easy to understand and highly accessible for expats from EU and non-EU countries. Some patients find that private facilities have shorter waiting times, more reliable services and a better quality of patient care than hospitals in the public sector.
9. Health risks
Except for routine vaccinations for travelers (influenza, chickenpox, polio, MMR, DPT and hepatitis B), there are no specific vaccinations required to enter Spain. The main risks for expats are sunburn, sunstroke and dehydration due to the warm climate.
In the case of a serious medical emergency, the number for an ambulance is 112 (calls to this number are free of charge). For expats with private healthcare insurance, private hospitals often have ambulances available, and these can be faster and more efficient than the public services. Most hospitals in Spain have accident and emergency (A&E) departments.
Free public healthcare is available to anyone who works and pays national insurance contributions in Spain. Though public healthcare is of a high standard, some expats still decide to invest in private healthcare as it is often considered faster, more reliable and of a better quality. Private healthcare is also a popular option with expats who don't speak Spanish and who are living away from the main tourist areas, as private services can sometimes allow them to request an English-speaking doctor.
Disclaimer: The information included in this article is provided for information purposes only and is not intended to constitute professional advice or replace consultation with a qualified medical practitioner. All information contained herein is subject to change.