Health System in Spain

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Health System in Spain: components, quality and limitations

Have you recently moved to Spain to live or work? Are you planning to retire in Spain? Are you going to use the public healthcare system or are you considering a private insurance? In this article, we briefly describe the Spanish health system, its components, quality, accessibility and some of the current aspects of concern and limitations that every expat should know to better navigate it while living in Spain.

1. The Public Health System (Sistema Nacional de Salud)

  1. Coverage: Spain has a public health system with Universal Coverage for every resident in the country, but you will need to get a health card (Tarjeta Sanitaria) to get full access to its services.
  2. Financing: Its financing is somewhat complex; it consists of a centralised nationwide revenue collection throughout taxation and a de-centralised resource allocation model for the provision of care. The public funds for healthcare are transferred to the regional governments for the delivery of care, which is commissioned by each of the 17 Autonomous Communities in which the country is geographically and politically divided.

  3. Provision: Hence, although the taxation is collected and pooled by the central government, the regional administrations manage the delivery of care and this leads to significant differences among regions in terms of their provision of public health care.
  4. Accessibility: As a patient, you basically have three ways to access the system: by registering to a Primary Health Centre, attending the ER department of a Public Hospital or, alternatively, you can call the emergency services (dial 112) and be treated or taken by ambulance if needed.

    Primary Health Centres (Centros de Salud) are the front door of the system and they are distributed geographically and citizens gets registered to the closest to their residency.

    Secondary care (Médicos Especialistas) is only accessible through the
    referral process that has to be initiated by the assigned GP (Médico de Atención Primaria) at the Primary Health Centre.  

    Note that, according to the Ministry of Health (, the average
    waiting time for a first clinic with the specialist is currently beyond 90 days

  5. Equity: Although access is universal for every resident in Spain however there are substantial differences in the available care, the distribution of resources or its use, contributing to the differences in life expectancy among the Spanish regions.
  6. Quality: As a whole, the Spanish Health System was ranked 7th in the controversial WHO ranking of health systems 2000 and more recently, Spain health system scored very high in an index of effective coverage, which accounts for the responsiveness of the system to its target population needs.  There is no doubt that Spain has a very good public health system, which contributes to its excellent figures in life expectancy, but inevitably there are variations between regions, hospitals, centres and professionals.

2. Private Health Sector

The private health sector has dramatically grown in the last two decades in Spain, reaching a level of activity that corresponds with approximately 30% of the total national cost in health. At present, about 45% of hospitals and 25% of the hospital beds belong to the private sector nationwide.

As in many other countries, there are the two main ways to access private health services:

  1. Private insurances. Which are normally chosen to supplement or complement the public health coverage so as to get a quicker access to health care or to be covered for interventions not accessible in the public health care. However, insurance companies are mere intermediary between patients and health providers and therefore, long waiting time and not availability of certain interventions also occur with these schemes, despite patients paying their premiums in time.
  2. Out-of-pocket payments. By a direct payment to the provider, patients get prompt access to health care, have the freedom to choose the hospital, the centre or even the specific doctor that they want. It normally establishes a link between the treating team and the patient in which the patient has a more active participation in the decision-making and the treatment plan. Costs for hospitalizations, surgical procedures or some specific treatments can be financially catastrophic though.

    SAMON medical services offers you an alternative solution to the inefficiencies and problems mentioned above while also helping you make a better use of whatever pre-paid health scheme (public or insurance) you may already have.

    SAMON is committed to provide quality health care, accessible to everyone, easy and ready for you at any time, from everywhere, as well as at a moderate and affordable cost.


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