Guide to the Spanish healthcare system

In 1998 the Sistema Sanitario Público (public health service) brought in an official mandate for both doctors and patients outlining the service to which you are entitled — plus what the health service expects from you. In any doctor’s office you should find these rights in a leaflet entitled Carta de Derechos y Deberes (Charter of Rights and Obligations) – only minimally different, if at all, in various provinces – which tells you everything in detail. Some small practices have posters on the wall containing all the facts you would find in the leaflet, but whatever the case you are entitled to view these rights.
Health insurance

It is not necessary to have private health insurance in Spain, and although there are many such insurance companies in the country, they are used mainly by people who feel more comfortable with private health insurance. If you have been brought over to Spain by a company you are probably provided with health insurance anyway, but there is no need for concern if you don’t have it. The public healthcare system in Spain is extremely good.

EU residents

Under a reciprocal agreement between European Union governments, residents of EU countries can receive free medical care when visiting another country. To make sure you qualify, get an E111 form, which is standard for all member states of the EU, before coming to Spain. It is usually available at post offices. If you are receiving a benefit for a disability or as a pensioner in your home country (within the EU) you should also ask your local Social Security office for a E121 form as this will be required for you to receive free prescriptions.
Spanish medical card
The EU reciprocal agreement covers you for treatment in Spain until you get an official Medical Card (Tarjeta de SS) from your local Social Security Office (INSS – Oficina del Instuto Nacional de Seguridad Social) in Spain. The office you require for the medical card is often to be found in clinics and some hospitals. If in doubt as to where to go for this you should ask at your doctor’s office. Applying for the card is not a difficult procedure and you should receive it within a very short time. You will need to show the official your E111/E121 (if you are an EU citizen) and other relevant documents such as your residence card or passport. If you are not from an EU country and still wish to benefit from the Spanish public insurance scheme you should telephone or visit your Spanish consulate before leaving your home country to inquire as to what forms you may need to take with you.

Doctors
As with any business or service, there are good and bad tales about Spanish medicine. However, it is safe to say that local doctors in Spain are as highly qualified as in any other EU country, sometimes more so. Under the Carta de Derechos y Deberes you may choose your own doctor — it is not necessary to be living in a particular area. You may choose your doctor from the phone book or from passing his or her clinic in the street, but it is always best, no matter what country you are in, to go by recommendation of a friend or neighbour. If you do not like this doctor you are entitled to change practices. It is very easily done: you just visit the new doctor and show him the same information you showed the preceding doctor. If you have been under treatment, however, it is wise to inform the second doctor of this so that your information may be transferred, in confidence, to your new practitioner. You may also choose to go to a Centro de Salud (healthcare centre), which usually has about half a dozen doctors. You may not always get the doctor you first went to, but they do endeavour to give you a sense of regularity.
At a Centro de Salud you must make an appointment, whereas many doctors with their own practices take patients in the order in which they arrive, You can find the address and telephone number of all the Centros de Salud in your region in the Yellow Pages.

Upon your first visit you must show the doctor or receptionist your E111/E121 form (plus a photocopy which they will keep for their records) or your medical card. From that he or she will enter the details onto their computer and determine also whether you are a pensioner (which covers disabilities also) or an activo, the latter being a person capable of paying for prescriptions. You do not need to pay your doctor for a consultation, or when referred to a specialist. Under the rights brought into effect in 1998 you are entitled to be accompanied by a person you trust, not necessarily family, at all times while visiting your doctor or specialist.

Dentists
Unless you have private health insurance which covers dental work, you must pay for treatment at the dentist. This is not overly expensive though, and as with many businesses and services in Spain, if you need time to pay, most dentists will allow this rather than making you pay on the day of consultation. Again it is best to go by a recommendation, if you can. The dental service in Spain is generally very good and efficient, with most practitioners having access to the latest in dental technology. You do not have to show any forms when visiting the dentist — simply make an appointment. It is, however, always advisable to take some form of identification with you.

Hospitals
Hosptials are generally very good, with an efficient and fairly rapid service. If it is an emergency you do not, of course, have to be referred by a doctor. You should ensure you have either your E111/E121 form or your medical card as they will wish to see this. The hospital might also ask for identification, as this is routine everywhere in Spain. Either your passport or residence card will suffice. You do not have to pay for any service other than prescriptions (if you are not a pensioner). If you are alone and an ambulance has brought you in for, perhaps, an x-ray to check something is not broken, an ambulance will also return you to your home, even if nothing is found to be wrong. If you have to stay in hospital and do not speak Spanish, you will find that even in smaller cities there are usually a couple of doctors and a nurse or two who can speak English. But if not, they will do their best to help you. If you do not speak the language it would be wise, if you do not have a friend who speaks Spanish, to at least take along your Spanish/English dictionary or phrasebook.

Pharmacies

You can buy many medicines over the counter in Spain that you may not have been able to at home, but if you are a pensioner it would be cheaper and more advisable to see your doctor and to get a prescription from him. In some countries there is a standard fee for prescriptions, no matter what they may be, but this is not the case in Spain where each item is priced differently. Still, you are likely to find that prescriptions in Spain are a lot cheaper than in many countries. Tablets (pastillas) in Spain do not come in bottles containing the exact number the doctor has prescribed. Instead they come in boxes with a set number of pills in the box. Therefore the doctor will write the prescription out accordingly as these boxes cannot be broken up. Pharmacies are usually open from 9.30 am until 2pm and from 5pm until 9.30pm Mondays to Fridays and from 9.30am until 2.30pm on a Saturday. In even the smallest of villages you will be able to contact a pharmacy in case of emergency 24 hours a day. Your pharmacy will give you the appropriate telephone number or you will find it in the front of your telephone book.

Emergency treatment

Throughout Spain the number to call for a medical emergency is 061. In each province however it would be wise to familiarise yourself with the address of your nearest hospital and its own emergency number.


Please Remember that this is written as a guide only.