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Your daily Spanish Law reporter. Have it with a cafe con leche.

Legal tip 26. Overview of the health system in Spain
13 January 2009 @ 13:09


Overview of the health system in Spain
All foreign employees and self employed workers must join the Social Security system in Spain and pay monthly contributions to social security through their employer.
 You will receive a social security card, which entitles you to free medical and hospital care. You can also hire a private insurance but treatment costs are not refundable except in certain emergency situations. In Spain 40% of medical treatment is private.

Treatment is free if you go to a doctor working in the Public social security system. If your illness requires special treatment, the doctor will send  the patient to specialists through a formal report.

The drugs are always prescribed by the doctor in a formal prescription note. Some medicines are not covered by social security.

Treatment in hospitals is free within the social security system, patients are also entitled to certain services, prosthetics, orthopedics, blood, etc… free of charge when necessary.

You can get private health coverage, addressing one of the many private medical companies in Spain. You can find them listed in the Yellow Pages as "Medical Societies."

 Regional Health Services of Autonomous Communities have assumed the powers, functions and financing for these services.  You can obtain a list of hospitals and health centers in the local Health system offices.
The State, through the National Health System, is the guarantor of quality and sufficiency of the services anywhere in the country. The network of hospitals associated with social insurance is managed by a state agency called INSALUD.

The Spanish state covers the health needs of all its citizens and residents through the National Health System, funded through taxes and run by the Autonomous Communities.

Over 90% of the population uses this system for their medical needs. This system allows the Spaniards and foreign residents to choose their General Practiciones, through which they gain access to the rest of the system.

Most patients get an appointment with their GP one day or two after the application. This does not entail any extra cost to patients, and the Regional government cover these costs.

Patients must be referred by the GP to see an specialist, except in emergencies. Unfortunately, as in most European countries, waiting lists for visits to specialists or for voluntary or non-emergency interventions are often long. Finally, the Spanish public health system covers only health care (with some exceptions), some  dental services and optical problems need to be treated by the Private Health system.

In recent years, private health has gained in importance. An estimated 15% of the population has private health insurance, including the majority of civil servants, who are given the option to choose between public and private. Insurance can be used either in addition or as an alternative to public health.

The advantage is that private insurance companies have their own network of hospitals, clinics and laboratories, so policy holders do not have to wait that long to be treated. The only problem is that companies can insist that the patients use only doctors who are members of their group. However, some company offer payment of 80% of Doctor´s bills non listed among those of their group. Major Private insurance companies are Adeslas, Asisa and Sanitas.

How to get health care?

As a foreigner can benefit both the public health system and private health Spanish.

Public health

Foreign employees working for a Spanish company and own-account workers in Spain have to contribute financially to the Spanish Social Security. These contributions entitle them and their families to a free or subsidized health care under the same conditions as a Spanish citizen. Although under Spanish law everyone has the right to free health care regardless of whether or not listed in the social security system.

 You need to approach the Health Center closest to your home to apply for the Health card with your residency card. You will receive a health card by mail after a few weeks.

If you are a citizen of the European Union, you are automatically entitled to free health care in Spain thanks to bilateral agreements between EU countries. Since mid-2004,  there is an European Health Insurance Card which simplifies the process of receiving medical care in EU countries. This card substitutes forms E111B and E111, E110, E128 and E119.

Private Health

Anyone can apply to private health. Companies often provide medical and dental care at a discount if you ask for General Policy and Specific dental policy. Prices vary depending on age and sex of the applicant, but they are not too high.The average cost of the premium for a man of 30 years starts with € 40 a month, while for women is a little higher, around € 50 a month.

If you are not covered by the social security system in your country or for any private insurance policy, you can receive treatment from any doctor, but you will have to pay in full.

Where to go in case of emergency?
In an emergency, go directly to the nearest emergency room if you do not have private insurance, go to a public center.

Although under Spanish law, any medical facility, whether public or private, has the obligation to treat patients in an emergency, regardless of their life insurance, this only applies in cases where a situation of life or death. The responsibility to decide depends on the doctor or nurse on duty. Use the emergency number 112 if you need an ambulance.

Finally, for a list of doctors who speak other languages, it is best to ask at the embassy or consulate in their country. Often have lists of doctors available to their citizens.

Where to go in cases of minor ailments?

Most people go to the pharmacy for minor ailments. They are easily identifiable by the bright green cross which appears on the outside wall or in the window.

Pharmacies take turns to provide  services outside of business hours (night and holidays) and pharmacies on duty. You can see what Pharmacy is on duty in the newspaper or watching in the window of any pharmacy, where they usually put a list.

Spaniard pharmacists are more educated than in other countries and can advise on treatments for many common diseases and ailments, but they are not a substitute for the doctor if it's a more serious problem.

Spain is not too restrictive in terms of  medicines availability. Medications typically cost far less than in other countries because of price limits imposed by the government.

Registration in social insurance and obtaining a health card?
Enrollment in Social Security.

 Legal workers always need a Social Security number. They are registered in the system when they are hired or self-employed.
It is illegal to have workers without their proper registration in the Social Security System.
This number is also of use for health issues of the worker and his/her family.
Once you have your number within the Social Security Syste, you can apply for Doctor allocation, which is an easy step to be implemented at the health center closest to your residence.

Card issuing and allocation of health.

To receive a health card (plastic card for Social Security) you need to go to the nearest health center in the town, and complete the form which is designed for that purpose. In this step, you can also choose among the list of  medical professionals of the health center, whos is called “ médico de cabecera o medico de familia” and who governs and monitors all the health care services which are needed by the insured . At this time, you receive just a sticker and will be sent by mail the plastic card within 30 days. You need to fill in as many forms as people dependents of the insured wish to register: a template for each child and the spouse.

¿Healthcare for illegal immigrants in Spain?

Healthcare is the provision of medical services and pharmaceuticals necessary to preserve the health of its beneficiaries. You just need to be registered in the Locan census for this healthcare, because otherwise the law is limited to emergency medical treatment for illness or injury until discharge.

All foreigners can register, although they are in Spain illegally. Minors and pregnant women have healthcare rights even if they are not registered in the Census.
Stone Fountain in Jewish village in Seville.

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