What’s Public Healthcare Like in Spain?

I’ve been lucky enough to experience both private and public healthcare in Spain. Both have been decently hassle-free and I would easily choose either  over healthcare in the States.

That being said, my experience with public healthcare in Spain, which included the birth of my first child has been, for the most part, a positive experience. In fact, having public healthcare was one of the reasons we felt confident when deciding to start a family in Spain.

How is it run?

Spain boasts a socialized public healthcare system. It is run by the government of each autonomous community (or state). My experience is specific to Madrid. I’m sure there will be discrepancies with how other regions in Spain run things. As well as how other areas of Madrid handle patient care. Anything government-run in Spain tends to vary widely based on where you are and who happens to be helping you.

Who is eligible for public healthcare?

Only those who are working, plus their dependents, are eligible. That means that employees are paying into the social security system or their employer is doing it for them. Once social security receives your first payment, then you are insured.

What if you aren’t eligible, but have an emergency?

Any hospital will treat you in the case of an emergency. I have heard cases of some people being billed for their visit, I’ve heard other cases where people were treated for free.

Irregardless of legal status, treatment for children under the age of eighteen and pregnant women should be covered by law. In some cases, they may have to be taken directly to the emergency room (as opposed to a doctor’s office).

How does it work?

Once employed, you will need to apply for a social security number. Then either you or your employer pay into social security. This comes from your paycheck and the payments are called cotizaciones.

Once you receive your social security number, you will need to register where you are living with your local city hall, or ayuntamiento. This is called an empadronamiento. The city hall will give you a form that certifies your current address. You will take your social security number and empadronamiento to your corresponding doctor’s office, or centro de salud. Doctors offices are assigned to you based on the neighborhood you live in.

At the centro de salud, they will print a temporary health insurance card for you while you wait for your physical card. They said it would take about a month to receive the card, but that will vary widely. My daughter received her card in less than a month, but my husband waited several months. The cards are delivered to the centro and they will call you when they are ready to be picked up.

Please note: You are free to see a doctor or specialist while you have your temporary card. The only downside is that any medication you are prescribed will not be discounted. More on that below.

How do you choose your doctor?

You must register with the centro de salud that is assigned to your area. At the same visit when you request your health insurance card you will also choose your general practicioner, or médico de cabecera/ médico de familia.

They will ask if you prefer appointments in the morning (before 3pm) or afternoon (after 3pm). Then assign you a doctor who works mornings or afternoons, based on your preference.

What if I don’t like my doctor?

You are free to change doctors at any time. This is called libre elección. There is one hiccup to this. If there is only one doctor in your assigned area, then you are stuck with them. In my case, my centro de salud has only one midwife, or matrón, who I did not like. Unfortunately, he (Can I call him my midhusband?) was the only midwife available to me based on my centro de salud and I wasn’t able to change.

How do I see a specialist?

No matter what the issue, you must always book an appointment with your médico de cabecera first. They refer you to whichever specialist you require. Yes, that means you will have a minimum of two doctor’s visits instead of just going directly to the specialist you need.

Is everything covered?

Overwhelmingly, yes. But, there are some things that randomly aren’t. Parents of young children can expect to shell out a couple hundred euros on certain vaccines that are not included in the government’s vaccine schedule. We’ve paid for the Rotavirus and Meningitis vaccines from our own pocket. Other items that I’ve heard haven’t been included include crutches and corrective helmets for babies with flat head syndrome. Again, due to the inconsistencies in Spain, in some cases these items have been included, in same cases they haven’t.

Is there a waiting period?

As far as I’m aware, no. And for that matter, pre-existing conditions aren’t a thing either.

What about prescriptions?

Prescription medication is sold at a reduced rate. However, in order to receive that discount you will need your official health insurance card. Your temporary card does not count. Your doctor will load your prescriptions onto your health insurance card, and you bring it to the pharmacy of your choice. No paper prescriptions, unless its a medication that is not covered by the public system.

What’s it actually like?

It’s different. The great news is that in comparison to the US, I’ve felt like I’ve received a comparable or better standard of care.

However, and this is a big however, Spanish doctors are generally lacking when it comes to bedside manner. I’ve been to the emergency room in a panic and not had a single doctor or nurse say a kind word. They were very dry, distant, and clinical.

Additionally, doctors offices and hospitals may not look aesthetically pleasing. And that’s OK. Things don’t have to look pretty, but they do need to function. Which it does.

Lastly, sometimes the way things work just don’t make sense. There were several doctor’s appointments I needed to cancel or reschedule but when I called, I was told I needed to come in person to the office (which was located across town) to make the change. Not online, and not over the phone. This was for a specialist, but still…

Overall, my experience with public healthcare in Spain has been overwhelmingly positive. I haven’t had to battle with insurance companies. I haven’t had to wonder if this or that test would be covered. I’ve never had to avoid going to the doctor because I couldn’t afford it. If I have a problem I go. Straight and simple.