If you are an expat living in Spain, it can be challenging to get your head around a different health system, and even more so if you don’t speak Spanish or Catalan.
The Spanish healthcare system is ranked among the best in the world and consists of both public and private healthcare, with some hospitals and healthcare centres (centros de salud) offering both in the same place.
Healthcare in Barcelona
Public healthcare
The public healthcare system is regulated by the government and provides free, standard healthcare to anyone who contributes to the Spanish social security system and also to their immediate family. Children, the elderly, the unemployed or people with a significantly low income also have access to medical care through the public healthcare system. Despite long waiting times, public service in Spain is generally of a very high standard. Pharmacists in Spain can also advise on minor medical problems and prescribe medicine without a doctor’s prescription.
However, optometry, audiometry and dentistry are not included in the standard state care and you must therefore pay separately for these services.
As an expat, you are fully eligible to access the public healthcare system if you are:
- Working in Spain and are paying Spanish social security contributions
- Living in Spain and receiving state benefits
- Under the age of 26 and are studying in Spain
- Receiving Spanish state pension or certain benefits
- Staying temporarily in Spain and have an EHIC card
- Pregnant or you are a child resident in Spain
How to register for public healthcare in Spain
To be able to register for public healthcare in Spain, you will first need to obtain a social security number. Once you have received your social security number take it to your local health centre to register and apply for a health card (tarjeta sanitaria individual or TSI).
Private healthcare
Private healthcare in Spain runs alongside the public system, with some hospitals offering both private (privado) and public healthcare services (asistencia sanitaria pública). Private health insurance is a very popular option for many people, especially expats.
The perks of private healthcare are; you will receive shorter waiting times for appointments and treatments, you will be able to choose which clinic, doctor or specialist you visit and you can decide whether you want to be helped in English.
The cost of private health insurance in Spain varies between €50-200 a month, depending on the company and the plan that you choose. Some of the largest private health insurance companies in Spain include; Allianz Care, BUPA Global and Cigna Global. However, any prescribed medicines will not be covered by your insurance and you will have to either pay for this yourself or go to the public GP to get it free of charge.
General Practitioners
The primary care services are guaranteed by the Catalan health service (CatSalut) and are part of the basic public healthcare. The Primary Care Centers (Centers d’Atenció Primària or CAP) are the first point of access to health care in Barcelona, here you can book regular appointments with the General Practitioner (GP).
There are many Primary Care Centers located all around Barcelona. The CatSalut will assign all citizens a specific CAP based on their address. However, if you require urgent medical care you should visit the Continuous and Urgent Care Center (Center d’Urgències d’Atenció Primària or CUAP) which are open 24 hours a day, including weekends and public holidays.
Dentist
The public healthcare system in Spain does not cover dental care, with the exception of the annual dental check-up and cleaning for children up to the age of 18. Therefore, unless you have private health insurance, you will need to pay for your dental treatment. Bear in mind that dentists in Spain typically require payment upfront.
Tarjeta Sanitaria Individual (TSI)
The Tarjeta Sanitaria Individual (Individual Healthcare Card) is a card that identifies individuals as users of the public healthcare system (CatSalut in Catalonia). It gives you free access to:
- All hospitals and services of the public e system (pharmacies, health centres (CAP) etc).
- Prescriptions subsidised by CatSalut.
How to apply for TSI
There are 3 steps you need to follow prior to receiving your card:
Step 1 Municipality
Register in the municipal register of inhabitants of the city of Barcelona.
Step 2 Fill in the form
You must print the form, fill it out and sign it. In addition, you must gather the required documentation. Identification Proof of registration with the municipality (with the date of issue less than three months). A copy of your social security number document
Step 3 CAP
Go to your primary healthcare centre (CAP) and submit the documentation required. If your application is successful, you will first receive a temporary card and CatSalut will send you the TSI card free of charge to your address.
If the request is made on behalf of another person, it will be necessary to provide the corresponding documentation of the legal representation, i.e. a birth certificate. However, bear in mind that the application for the first individual healthcare card must be signed by the person applying for it.
In order to request a medical certificate to be absent from work due to illness and also to return to work after illness, you must present your Tarjeta Sanitaria Individual at your local healthcare centre.
It is important that the information on your card is correct and up to date.
The card is individual and non-transferable; therefore, each family member must have his or her own Tarjeta Sanitaria Individual.
If you go to the accident and emergency department, you do not have to present your card. However, the card must be presented subsequently in order to prevent the user being charged for the services.
While this formality is free of charge, bear in mind that there may be a fee to have the card reissued.
Tarjeta Sanitaria Europea (TSE)
The European Health Card, also known as the EHIC or Tarjeta Sanitaria Europea (TSE) in Spain, gives you access to state-provided healthcare throughout the European Economic Area (EEA) and Switzerland either free of charge or at a reduced rate.
Long-term Spanish residents:
If you are permanent resident in Spain and you’re affiliated with the Spanish Social Security system (Seguridad Social), you can apply for your card and use it when you travel to other EU countries (including your country of origin). If you don’t have the card, you may be considered as a private patient and will have to pay for the cost of any treatment you receive.
The card is free to obtain and is valid for two years, you can apply online via the link below or at any of the Social Security Offices (INSS).
Short-term Spanish residents:
If you are only planning on residing in Spain for a couple of months and you have already been issued an EHIC (European Health Insurance Card) from your previous country of residence, this will entitle EU residents to free public healthcare for the first three months of their stay in Spain.
Bear in mind that this only covers emergency treatment and is not valid for Spanish residents, therefore you must be prompt when registering with the Spanish Social Security system in order to take advantage of the healthcare system in Spain.
