Health insurance and medical care in Spain

Living in Europe | Health insurance, Medical care | Spain

 

SPANISH NATIONAL HEALTH SYSTEM

The National Health System, SNS, is a coordinated network of nationally and locally administered Health Services, comprising all health functions and services which are the legal responsibility of the public authorities.

Its most important features are:

  • Health services which are publicly funded, universal, and free to use.
  • Defined rights and duties for citizens and public authorities.
  • Political decentralization of healthcare in the Autonomous Regions.
  • Provision of comprehensive high-quality healthcare which is duly monitored and evaluated.

For further information, consult the Ministry of Health, Social Services and Equality´s website. http://www.msssi.gob.es {available in Spanish, English and French}

Medical and Pharmaceutical Care

Each Autonomous Region has a Health Service, which is the administrative and management structure comprising all centres, services and establishments of the region, provincial councils, city councils and any other administrative bodies of the region.

Following the transfer of healthcare responsibilities, all Autonomous Regions are now accountable for healthcare in their regions. In the Cities of Ceuta and Melilla, which have Statutes of Autonomy, the Central State Administration continues to manage healthcare through the National Health Management Institute (INGESA).

Entitlement to health protection and care 

In Spain, healthcare is guaranteed by the National Health System, funded by the State, to persons with the status of Insured or beneficiary of an Insured.

 

Persons in one of the following situations have the status of Insured:

  1. Employed or self-employed persons, registered or similar with the Social Security System.
  2. Those with the status of pensioners in the Social Security System.
  3. Recipients of any other regular benefit from the Social Security System, including unemployment benefits.
  4. Those who have exhausted their unemployment benefit and remain unemployed, their Insured status not being accredited by any other means.

 

In those cases in which none of the aforementioned situations are applicable, nationals of Spain or of a Member State of the European Union, the European Economic Area or Switzerland who reside in Spain, and foreign nationals authorised to reside in Spanish territory, may hold the status of Insured provided that they can prove that they do not have an annual income of more than €100,000. Those with the status of beneficiaries of an Insured are - provided that they reside in Spain - a spouse or person with analogous relationship, an ex-spouse dependent on the Insured, and descendents or equivalent persons dependent on the Insured who are under 26 years old or who have a disability equal to or greater than 65%. Foreign nationals authorised to reside in Spanish territory have the same right to healthcare as Spanish nationals.

 

Those who are not registered or authorised as Spanish residents will receive healthcare in the following circumstances:

  1. Emergency care for a serious illness or accident, whatever its cause, until discharged.
  2. Pregnancy, birth and postpartum care.

In all cases, foreign nationals under 18 years old may receive healthcare under the same conditions as Spanish nationals.

 

Sincrotrón Alba

AlbaSynchrotron

 

MEDICAL AND PHARMACEUTICAL CARE LEVELS OF SNS

The National Health System, SNS by its Spanish name, as a provider of healthcare services, is organised on two levels: Primary Care and Specialised Care.


The principal care mechanisms in Primary Care are the Health Centres, in which a multidisciplinary team of family doctors, paediatricians, nurses and administrative staff are employed, together with social workers, midwives and physiotherapists.


Specialised Care is provided in Specialist Centres and Hospitals for outpatients and inpatients. Emergency care is offered at the hospitals twenty-four hours a day to patients who have not been admitted to hospital.

The directories for Primary Health Care Centres and Hospitals are available on the web page of the Ministry of Health, Social Services and Equality: http://www.msssi.gob.es/ciudadanos/prestaciones/ {available in Spanish, English and French}.


In addition to the above, Emergency Care is the care provided to a patient in the event that their clinical condition requires immediate emergency care. This care is provided at the health centres and outside the centres, including at the patient’s home, on a 24 hour basis, with the provision of medical and nursing care, and the collaboration of other professionals.

 

The provision of healthcare is managed through the common services portfolio of the National Health System, which is divided into three categories according to the contributions made by the user:

  1. Basic common portfolio: Includes care for the prevention, diagnosis, treatment and rehabilitation of illness provided in health centres or social-health centres, together with emergency health transport, and is completely covered by public funding.
  2. Supplementary common portfolio: this includes all the services provided through outpatient stay (pharmaceutical, orthoprotesic provisions including dietary products, and non-emergency health transport). These are subject to user contributions under the same conditions as those regulating pharmaceutical provisions (see 5.4.1.4 below), taking as the base for calculation the final product price, without applying any limit to the contribution.
  3. Common portfolio of accessory services: this includes those activities, services or techniques that are not considered essential but which help to improve a pathology, and are subject to the user’s contribution and/or repayment.

Levels of SNS Care

Primary Healthcare

Specialised Care

Characteristics Accessibility Technical complexity
Activities Promoting health and the prevention of disease with a technical capacity for resolution that completely covers the most frequent health issues It has highly complex and costly diagnostic and therapeutic facilities, the efficency of which improves if concentrated in one place
Access Spontaneous Referred by the Primary Care specialists
Care mechanism Health Centres and Local Clinics Specialist Centres and Hospitals
Care regime At the Centre and at patient's home Outpatients and inpatients

Social Security HealthCare

Social Security HealthCare/ Source: Social Security Website http://www.seg-social.es

 

Individual health card

Access to the services is via the Individual Health Card issued by each Health Service. This document identifies each citizen as a user of the National Health System.

The format and content of the Individual Health Card, and its issue and delivery to holders, is the responsibility of the health system. It can be obtained from the corresponding health centre (primary care) according to the individual’s place of residence. However, prior to this, the individual should be recognised as insured and entitled to benefits by the National Institute of Social Security (INSS). Entitlement to healthcare starts on the day the individual is signed up to the system, both for the insured (employed researcher) and for their beneficiaries (family). Recognition of the insured is automatic (automatically recognised by the INSS), but it is necessary to submit an application in the case of family members (beneficiaries) who do not work in Spain: the application (accompanied by a copy of the individual’s passport and Foreign National Identity Card or the entry in the Central Registry of Foreign Nationals in the case of European Union citizens, in accordance with the Agreement on the European Economic Area or Switzerland) may be submitted at any Social Security Office.

Pharmaceutical care

The National Health System covers all the medicines dispensed during hospital stays. In the case of outpatients, medicines prescribed in a

National Health System prescription are paid for jointly[1] according to the user’s income. In the case of chronic treatment, the percentage participation is 10% with a maximum of 4.20 Euros.

[1] In Catalonia, a contribution of one Euro per prescription is added to the general contribution (known as a “user excess”) for those medicines costing more than 1.67 Euros. The maximum sum payable by a user in this concept is 61 Euros.

Percentage contribution of user according to income for the purchase of medicines.

Source: Graph by these authors.

Labour force

Pensioners

Individuals in receipt of minimal income, unemployed individuals not in receipt of unemployment benefits, individuals in receipt of non-contributory pensions, etc.

0%

Code: TSI 001

0%

Code: TSI 001

Income below €18,000

40%

Code: TSI 003

10%

Code: TSI 002

Upper limit of 8,14€/month

 

Income equal to or higher than €18,000 and lower than €100,000

 

50%

Code: TSI 004

10%

Code: TSI 002

Upper limit of 18,32€/month

 

Income equal to or higher than €100,000

 

60%

Code: TSI 005

60%

Code: TSI 005

Upper limit of 61,08€/month

 

Mutual fund holders and state pensioners[*]

[*] State pensioners here refers to civil servants, members of the armed forces and justice officials.

30%

Code: TSI 006

 

ADDITIONAL INFORMATION 

The European Health Insurance Card makes it easier for individuals from any of the Member States of the European Economic Area (including the 27 members of the European Union, Iceland, Liechtenstein and Norway) and Switzerland, to access healthcare services during their temporary visits abroad.

 

Holders of the European Health Insurance Card will receive treatment in the same conditions as Spanish residents with respect to conditions and costs. If the same service is provided free of charge in the country of origin, the costs of this service may be reimbursed on the individual’s return to the source country.

The European Health Insurance Card is not valid when the purpose of the foreign national’s displacement is to receive medical care. Nor does the card in Spain cover care provided by private healthcare providers.

For further information, please see the web page of the European Commission’s Directorate General for Employment, Social Affairs and Inclusion: http://ec.europa.eu/social {available in the official languages of the European Union}

Individuals requiring private medical care may take out medical insurance in the country of origin that provides cover in Spain, or take out insurance with any private medical insurance company in Spain. It is important to remember that many of these companies have grace periods which may range between several months and one year before it is possible to draw on any of their services, especially in the case of maternity and surgical operations.

A brief list is provided below of the main companies. For a more complete list, please visit the Yellow Pages online and look under the headings “insurance, “medical companies” or “medical insurance”.

ADESLAS Tel.: 902 200 200 http://www.adeslas.es

ASISA Tel.: 902 010 010 http://www.asisa.es

MAPFRE Caja Salud Tel.: 902 20 40 60 http://www.mapfre.com/salud/

SANITAS Tel.: 902 102 400 http://www.sanitas.es

​When contracting any of these services, it is recommendable to check prices because in some cases, in addition to monthly or annual premiums, there is a fee for consultations. It is also important to check the national and international cover provided by these insurance policies. There are some companies which allow the Insured to choose the medical staff that suits him/her most, subsequently reimbursing a certain amount of the fees the insured has paid to the specialist.

In Spain, medicines are only available in pharmacies.

Normally, the user is required to present the prescription issued by the healthcare specialist. Pharmacists’ opening hours are the same as those of other commercial establishments. At weekends, there are duty pharmacists (your usual pharmacist will provide a list on the door of the address of the nearest duty pharmacist). Lastly, some pharmacies are open 12 and up to 24 hours a day. When requesting a medicine, pharmacies stock generic brands in addition to recognised brands, which are usually much cheaper and contain the same active substances. Homoeopathic medicines are also distributed at the pharmacist.

The website of the General Council of Pharmaceutical Associations in Spain (http://www.portalfarma.com) offers considerable information about the Spanish pharmaceutical system.

 

USEFUL ADDRESSES

Ministry of Health, social Services and Equality.

Paseo del Prado, 18-20, 28071 Madrid, Tel. 901 400 100

http://www.msssi.gob.es {available in Spanish,English and French}.

National Institute of Health Management, INGESA.

Calle Alcalá, 56, 28071 Madrid, Tel. 91 338 03 65/00 51

http://www.ingesa.msc.es {available in Spanish,English and French}.

    Autonomous Regions

     

    Health Councils

     

    Health Services

     

    Andalucía

     

    Consejería de Salud

    Av. De la Innovación s/n,

    Edif Arena 1- 41020 Sevilla

    Tel.: 955 00 63 00

    Servicio Andaluz de Salud (SAS)

    Av. De la Constitución, 18 - 41071 Sevilla

    Tel.: 955 01 80 00

    Aragón

     

    Dpto. Sanidad, Bienestar Social y Familia

    Vía Universitas, 36 - 50009 Zaragoza

    Tel.: 976 71 40 00

    Servicio Aragonés de Salud

    Paseo María Agustín, 16 - 50071 Zaragoza

    Tel.: 902 555 321

    Asturias (Principado de)

     

    Consejería de Sanidad

    Ciriaco Miguel Vigil, 9 - 33006 Oviedo

    Tel.: 985 10 85 00

    Servicio de Salud del Principado de Asturias (Sespa)

    Plaza Carbayón, 1 - 33001 Oviedo

    Tel: 985 10 85 00

    Baleares (Islas)

     

    Consejería de Salud, Familia y Bienestar Social

    Plaça d’Espanya, 9 - 07002 Palma

    Tel.: 971 17 69 69

    Servicio de Salud de las Islas Balerares (ib-salut)

    Reina Esclaramunda, 9 - 07003, Palma de Mallorca

    Tel.: 971 17 56 00

    Canarias (Islas)

     

    Consejería de Sanidad

    Avda. Juan XXIII , 17 - 35071 Las Palmas de G. Canaria

    Tel.: 928 11 88 52

    Servicio Canario de Salud

    Avda. Juan XXIII , 17 - 35004 Las Palmas de G. Canaria

    Tel.: 928 11 88 52

    Rambla Santa Cruz, 53 - 38071 Sta.Cruz de Tenerife

    Tel. 922 47 42 01

    http://www.gobcan.es/sanidad/

    Pérez de Rozas, 5, planta 4ª - 38004 Sta. Cruz Tenerife

    Tel.: 922 47 58 14

    http://www.gobiernodecanarias.org/sanidad/scs/

    Cantabria

     

    Consejería de Sanidad y Servicios Sociales

    Federico Vial, 13 - 39009 Santander

    Tel.: 942 20 82 40

    Servicio Cántabro de Salud

    Avda. del Cardenal Herrera Oria, s/n - 39011 Santander

    Tel.: 942 20 27 70/72

    Castilla y León

     

    Consejería de Sanidad

    Paseo de Zorrilla, 1 - 47007 Valladolid

    Tel.: 983 41 36 00

    Gerencia regional de la Salud

    Paseo de Zorrilla, 1 - 47007 Valladolid

    Tel.: 983 32 80 00

    Castilla la Mancha

     

    Consejería de Sanidad y Asuntos Sociales

    Avda. Francia, 4 - 45071 Toledo

    Tel.: 925 26 70 99

    Servicio de Salud de Castilla La Mancha (SESCAM )

    Av. Rio Guadiana, 4 - 45071 Toledo

    Tel.: 900 25 25 25

    Cataluña

     

    Departamento de Salud

    Traverssera de les Corts, 131-159, Pabelló Ave María

    08028 Barcelona

    Tel.: 93 227 29 00

    Servicio Catalán de Salud (CatSalut)

    Travessera de les Corts, 131-159, Edificio Olimpia

    08028 Barcelona

    Tel.: 93 403 85 85

    Ceuta

     

    Consejería de Sanidad y Consumo

    Pza de San Amaro, 12 - 51071 Ceuta

    Tel.: 856 20 06 80

    Delegación del INGESA

    Avda. Marina Española, 23, 1º - 51001 Ceuta

    Tel.: 956 51 49 29

    Valencia (Region)

     

    Consejería de Sanidad

    Micer Mascó, 31-33 - 46010 Valencia

    Tel.: 963 86 66 00/28 00

    Agencia Valenciana de Salud (AVSA )

    Micer Mascó, 31-33 - 46010 Valencia

    Tel.: 963 86 66 00

    Extremadura

     

    Consejería de Salud y Política Social

    Avda. de las Américas, 2 - 06800 Mérida

    Tel.: 924 00 41 00

    Servicio Extremeño de Salud (SES)

    Avda. de las Américas, 1 - 06800 Mérida

    Tel.: 924 38 25 01/02

    Galicia

     

    Consejería de Sanidad

    Edif. Admtvo. San Lázaro, s/n - 15073 Santiago de Compostela

    Tel.: 981 54 27 12

    Servicio Gallego de Salud (SERGAS)

    Edif. Admtvo. San Lázaro, s/n - 15073 Santiago de Compostela

    Tel.: 981 54 27 12

    La Rioja

     

    Consejería de Salud y Servicios Sociales

    Villamediana, 17 - 26003 Logroño

    Tel.: 941 29 13 96

    Servicio Riojano de Salud

    Villamediana, 17 - 26003 Logroño

    Tel.: 941 29 76 60

    Madrid (Community)

     

    Consejería de Sanidad

    Aduana, 29, 2ª planta - 28013 Madrid

    Tel.: 91 586 70 00

    Servicio Madrileño de Salud (SERMAS )

    Pza. Carlos Trías Beltrán, 7 - 28020 Madrid

    Tel.: 91 586 72 27

    Melilla

     

    Consejería de Bienestar Social y Sanidad

    Ramírez de Arellano, 10, 3ª pl. - 52001 Melilla

    Tel.: 952 69 93 01

    Delegación del INGESA

    Pza. del mar s/n. Edificio V Centenario Torre N, pl. 11 - 52071 Melilla

    Tel.: 952 67 23 12

    Murcia (Region)

     

    Consejería de Sanidad y Política Social

    Avda. de la Fama, 3 - 30071 Murcia

    Tel.: 968 37 51 83

    Servicio Murciano de Salud

    Ronda de Levante, 11 - 30008 Murcia

    Tel.: 968 36 59 00

    Navarra (Region)

     

    Departamento de Salud

    Amaya, 2 - 31002 Pamplona

    Tel.: 848 42 35 41

    Servicio Navarra de Salud (OSASUNBIDEA)

    Irunlaterra, 39 - 31008 Pamplona

    Tel.: 848 42 88 00

    País Vasco

     

    Departamento de Sanidad y Consumo

    Donostia-San Sebastian, 1 - 01010 Vitoria-Gasteiz

    Tel.: 945 01 85 00

    Servicio Vasco de Salud (OSAKIDETZA )

    Álava, 45 - 01006 Vitoria-Gasteiz

    Tel.: 945 00 60 00