Spanish Healthcare; Treatment Options within a System in Crisis


This article is brought to us by Cooper, Claridge-Ware, an independent International Health Insurance Brokerage headquartered in Hong Kong, China with more than 55 years of experience in helping expatriates and travellers around the world find the best insurance solutions possible.


In a departure from our previous articles, which have focused on the healthcare and insurance options available in a number of Asian travel destinations, this month we will be examining the healthcare and health insurance situation in Spain.

While millions of travelers visit Spain every year, the country is in a troubled situation. With over 27 per cent unemployment (57 per cent unemployment for individuals under the age of 25), and the national debt standing at €627 trillion, the Spanish government has been forced to implement a raft of austerity measures; measures which have been met with less a less than delighted reception by the Spanish public.

The economic crisis is still going strong in Spain, and although the country’s many tourist hot spots are still going strong and travelers are still able to fully enjoy the nightlife in Barcelona or watch Real Madrid play in the Bernabeu, it is a simple fact that the once all-encompassing social systems in Spain are not what they used to be. As such, all travelers to the country should be aware of their options in the event of an accident or an emergency – especially in regards to situations where the visitor may require healthcare.

Spain may be in the midst of an economic crisis, but it still has a lot to offer visitors.

Spain may be in the midst of an economic crisis, but it still has a lot to offer visitors.

Prior to the economic collapse Spain experienced during 2011 and 2012 the country’s healthcare system was extremely robust and all encompassing; Spanish hospitals and doctors provided some of the highest quality medical care in Europe. Similar in structure to Britain’s National Health Service (NHS), anyone paying into the Spanish social security system was able to receive medical treatment at a government run hospital free-of-charge. This meant that, for residents, health insurance was not a necessity in the country, although 26% of all healthcare expenditure in 2010 came from private sources – including private hospitals, doctors, and health insurance.

Today, the Spanish healthcare system is undergoing extensive reforms in an effort to alleviate the burden that the system placed on the country’s finances. With two new laws introduced during 2012 in the form of Royal Decree-Act 1672012 and Royal Decree 1192/2012 the Spanish government is attempting to implement stronger regulations as to who is able to receive medical treatment from the public system, while also updating the payment and financing system for available healthcare services.

Even though these reforms have been introduced against the backdrop of economic uncertainty and a growing need to ensure more accountability within the country’s social service provisions, the overall structure of the Spanish healthcare system remains much the same as it did in 2010.

If you are registered to work in Spain and have been paying into the country’s national insurance fund then you are eligible to receive healthcare and medical treatment at state-run hospitals and facilities on the same basis as a Spanish national. Individuals and families who earn less than €100,000 per year, who were registered as Spanish residents prior to April 24th 2012, who do not hold private health insurance or qualify for healthcare protection through alternative means may be eligible for healthcare on the same basis as Spanish nationals and may be accepted into the national healthcare system on a case-by-case basis.

So while tighter controls and restrictions have been implemented on the Spanish healthcare system as a whole, foreign nationals who are resident in the country are still able to receive high quality medical services provided at low-cost, or free-of-charge, through government-run state medical facilities. However, travelers should be aware that, for short term stays in the country, they may not be eligible to receive healthcare (should it be required) under the same manner as a Spanish resident.

Travelers who are citizens of a European Union member nation, who hold the European Health Insurance Card (EHIC) are eligible to receive medically necessary state-provided healthcare services during a temporary visit to Spain. It is important to understand that the EHIC will ensure that you receive healthcare under the same conditions (and for the same cost) as individuals who are insured through the Spanish national insurance scheme, but it is not a substitute for travel insurance – the EHIC card does not cover private healthcare services or a return flight to your home country in a situation where you require emergency evacuation.

Despite austerity measures, Spain has a top-notch healthcare system.

Despite austerity measures, Spain has a top-notch healthcare system.

Furthermore, travelers from an EU country should note that the EHIC does not provide protection against the costs of pre-planned medical treatment. If you are travelling to Spain for the express purpose of receiving healthcare then you will be unable to receive coverage against the costs of that treatment through the EHIC. However, it is important to note that even if you are receiving emergency medical treatment in Spain through the European Health Insurance card, you will still have to provide payment for services which carry a cost in the country – for example, this includes payment of prescriptions, which would be free of charge for residents of the United Kingdom.

Outside of the EU, Spain has a number of bilateral healthcare agreements with countries including Andorra, Brazil, Chile, Ecuador, Paraguay and Peru. Citizens of these countries requiring medical treatment in Spain are able to receive emergency medical treatment free of charge by providing the relevant healthcare certificate from their home country. In the event that an individual from one of these nations does not have their healthcare certificate on hand, they can receive reimbursement (in much the same way as a traditional international health insurance policy) through their country’s national healthcare system on their return home.

Travelers in Spain who are not citizens of a European Union nation, and who are not citizens of a country with which Spain has a bilateral healthcare agreement, including the US, are not eligible to receive medical treatment on the same basis as a Spanish resident. Consequently, travelers who fall into this category will need to provide payment for any medical services they receive whilst in the country. As such it is recommended that these individuals purchase a comprehensive travel insurance or global health insurance policy to provide healthcare protection for the duration of their stay in Spain.

No matter whether you are able to receive healthcare in Spain on the same terms as a Spanish resident or if you having to pay for your care as a visitor to the country, you can rest assured that, in the event of an emergency, Spanish hospitals will be able to provide extremely high levels of care. Spanish hospitals, both within the public and private systems, are normally very well equipped and the doctors are educated to an extremely high standard – both in the major cities and throughout the more rural areas of the country. The country’s healthcare system has been designed to ensure that a medical center is always within 15 minutes’ drive from a person’s place of residence; meaning that emergency assistance and treatment options are always accessible.

The major problem which many visitors will encounter when visiting a Spanish hospital is the lack of spoken English. There are, however, a number of voluntary translation services that can assist you with receiving your medical care and can be booked at the same time as you schedule an appointment to see a doctor.

The Bottom Line on Spanish Healthcare

Overall the Spanish healthcare system is of an extremely high standard, even when considering the unfortunate events which have impacted the country’s overall economy. Whether you are planning to stay in Spain permanently, or are just passing through as a visitor, your healthcare options are diverse and all-encompassing, ensuring that you are able to get the treatment you need when you need it. However, there are multiple regulatory levels which can apply to a range of different nationalities in different ways; as such, it is important that you fully understand how these regulations and upcoming reforms will affect your ability to receive healthcare, and the basis under which you are treated. If there is any uncertainty about your healthcare status in Spain it is always a good idea to consider a comprehensive global travel insurance plan.

About Cooper, Claridge-Ware

Cooper, Claridge-Ware (CCW) is an independent International Health Insurance Brokerage headquartered in Hong Kong, China. With more than 55 years of experience in helping expatriates and travellers around the world find the best insurance solutions possible, CCW helps to simplify the process of identifying, and obtaining, high-quality medical coverage no matter where you may be.

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An International Health Insurance Brokerage headquartered in Hong Kong with 55 years of experience in helping expatriates and travellers find the best insurance solutions.