How does the Spanish health system work?

Are you planning to buy a property on the Costa Brava in the near future?

Before taking any steps, it is essential to know certain things about the health system in Spain, as it can vary from one country to another.

Find out about them by reading our article.

The health system in Spain

Its performance

First of all, it should be noted that the Spanish healthcare system was ranked by the Legatum Institute, a London-based research institute, as the 16th best in the world out of 167 countries analysed, ahead of France (coming in 18th place).

Indeed, some hospitals are world-renowned for their state-of-the-art technology and the quality of their doctors' training. As proof of this, every year more than 20,000 people from all over the world come to Catalonia's hospitals to receive treatment or undergo surgery.

It should also be noted that the survival rate after the most complex operations is among the highest in the world.

Furthermore, according to Expatica, "Spain spends around 10% of its GDP on its health services and ranks 6th in the European Union in terms of the number of doctors, with around 4 doctors per 1,000 people".

As in our country, the Spanish health system is divided between the public and private sectors.

The public health system: SNS

Spain's public health system, known as the Sistema Nacional de Salud (SNS), is used by more than 9 out of 10 of the country's inhabitants.

The main specificity of the public healthcare system is that the Spanish social security system guarantees free healthcare to all its citizens with an identity number and a social security number. Unlike France, there is no need to advance fees.

Secondly, there are substantial subsidies on medicines ranging from 60% for employees to 100% for pensioners.

Another important feature is the Centro de Salud with a care path to be respected. Doctors, paediatricians and nurses from the public sector are grouped together in the Centro de Salud (or care centres) where they have to go for consultations. As soon as you are registered with the social security, a doctor will be appointed for you by the Centro de Salud as well as a paediatrician if you have children.

Each appointment must be made with these professionals and it is up to them to refer you to specialists or a public sector hospital if necessary. By following the care pathway, consultations are free of charge and prescribed medicines are partially or fully reimbursed. On the other hand, as in France, the delays to obtain an appointment with a specialist are quite long.

How can I benefit from Spanish social security?

Who can register?

The Spanish public health system is open to

• self-employed persons
• jobseekers (after working in Spain)
• people with an employment contract in Spain
• beneficiaries of a pension paid by a Spanish organisation
• spouse and dependent children under 26 years of age
• people who export their rights to French health insurance: pensioners, civil servants, seconded workers

In the latter case, the benefits are those of the SNS, which will then be reimbursed by the French social security system.

While waiting to take the necessary steps in Spain or if you intend to reside there for a fixed period, you can also access care in public health centres without having to pay the costs in advance thanks to your European Health Insurance Card.

What are the steps?

First of all, in order to register for social security, you must go to the following address
to the Tresorería de la Seguridad Social nearest to your home or via the Social Security electronic office (put external link: https://sede.seg-social.gob.es/) if you have an electronic certificate.

The documents to be provided are :

• Your identity document (identity card or passport) with a photocopy of
• Your foreign identity number (NIE or Número de Identidad de Extranjero) with a photocopy
• Your certificate of empadronamiento or municipal padrón, which confirms your registration in the register of your municipality of residence
• Your resident card
• The TA1 form filled in with your information
• Completed Form TA.0521 if you are self-employed and Form S1 (or E121) if you are exporting health insurance rights
• The documents of your dependents (spouse, child(ren)...)

Beforehand, in order to obtain the required documents, you must first take the necessary steps to obtain the NIE and the Padrón Municipal.

At the end of this appointment, a document with your social security number will be given to you directly.

With the same file and this document, you must go to the Centro de Salud closest to your home in order to complete your registration. The health centre will give you your provisional social security card, which will mention the name of the attending doctor and the paediatrician (if you have children) who have been assigned to you.

Until you get your "Tarjeta Sanitaria" or definitive insurance card (one to two months later), you can then benefit from the Spanish health care system.

Is it necessary to subscribe to a mutual insurance company?

First of all, you should know that private health insurance in Spain does not have the same role as in France. Indeed, the organizations do not supplement the reimbursements from the social security since in the public sector, there is no excess of fees.

On the other hand, they do reimburse the cost of consultations and treatment by private sector doctors. Therefore, if you consult a health professional who does not work in the public sector, it may be interesting to subscribe to a mutual insurance company or to an insurance with Axa santé, Contigo France santé or Mapfre salud .

This will also allow you to get better reimbursements for your dental or ophthalmological consultations and treatments (very poorly reimbursed by the Spanish Social Security) and to have an appointment with a specialist more quickly (given that in the public sector, the course of treatment must be respected and waiting times can be long).

Each private insurance company has its own list of doctors and specialists for whom consultations will be reimbursed. Therefore, before taking out health insurance, you should check that the contract will cover your care and consultations with the chosen health professional.