Health and Hospitals

HEALTH SERVICE WITHIN NERJA, TORROX, FRIGILIANA IN SPAIN

Each of the 17 regions in Spain is responsible for the provision of healthcare in the region. Central government simply oversees the budget. There are a wide range of clinics, hospitals and surgeries within each region and healthcare is available either free or at a very low cost to those who are enrolled and contribute to the social security system.

Most residents are no more than 15 minutes away from the nearest health centre and there is the facility to be seen at home if needed. In rural areas clinics may only be open on a part-time basis and staffed by professionals from different health centres around the region. Most hospitals have an accident and emergency department and there are smaller accident units at some health centres (centro de salud). Occasionally it may be the case that you need to travel to another area if the facilities for treatment are not available locally. It is normal when needing surgery in Spain to be added to a waiting list although these are generally not as long as the waiting lists in the UK. Many people will have private healthcare insurance for situations where they need surgery in order to avoid waiting, so this keeps waiting lists at a minimum. Spanish medical staff deal only with medical treatment, all other care is expected to be provided by the family or carers.

It is considered that the overall standard of healthcare in the country is good and in most hospitals there are staff who can speak English. If you should need to visit a health centre then they can often arrange for an interpreter if one is needed.

The Spanish healthcare system is ranked among the best in the world. Here´s how to sign up to free state healthcare in Spain, or apply for health insurance. 

If you're living and working in Spain you'll likely have access to Spain's free state healthcare, paid partly by social security payments, which will be deducted from your wage.

The Spanish healthcare service is regularly rated among the world´s best, guaranteeing universal coverage and no upfront expenditure from patients apart from paying a proportion of prescription charges. Spain spends about 10 percent of its GDP on healthcare, and is ranked 6th in the EU for the number of doctors with around four doctors per 1,000 people. A 2012 World Health Organisation survey showed that Spanish women outlive all other nationalities (living to 85.1 years) apart from the Japanese, so they must be doing something right.

Public and private healthcare in Spain
Spanish healthcare consists of both private and public healthcare, with some hospitals (hospitales) and healthcare centres (centros de salud) offering both private (privado) and state healthcare services (asistencia sanitaria publica). You don´t need to have private health insurance to get medical treatment in Spain but it usually allows you to get faster treatment for non-emergency procedures.
The state health system in Spain
State healthcare is free of charge to anyone living and working in Spain, although in some of the Spanish islands you may have to travel to find a state healthcare provider.
As an expat, you are entitled to free state healthcare if you are:
resident in Spain and work in employment or self-employment and pay social security contributions, resident in Spain and receiving certain state benefits, resident in Spain and recently divorced or separated from a partner registered with social security, a child resident in Spain, a pregnant woman who is resident in Spain, under 26 and studying in Spain, a state pensioner, or staying temporarily in Spain and have an EHIC card (see below).
If you don´t have the right to state healthcare you have to organise private health cover. If you have been registered on the padron at your town hall for a year, the Spanish government has a state insurance scheme (convenio especial) with a basic monthly fee. This is administered by the authorities in each autonomous region. The state system is funded by social security contributions, with each region of Spain taking individual responsibility for a health budget allocated by central government. As the healthcare system is decentralised, you will need to check the conditions in your own area for using healthcare services. There´s a directory of the regional health authorities within the different regions of Spain on the Spanish health ministry´s website (mainly in Spanish).

Private healthcare in Spain
If you are not paying social security contributions, then you can choose to take out private health insurance or pay the full amount of any medical costs.

How to register for Spain's public health care
First of all, you must register with social security (Direccion General de la Tesoreria General de la Seguridad Social or TGSS), which has offices throughout Spain, to get a social security number. You´ll need to show your passport or ID card, residency certificate and a completed application form. You´ll also need to have registered your details (address etc.) at your town hall.

Once you have registered with the TGSS you´ll be given a social security number and a certificate stating that you´re entitled to medical help. You then take the certificate, passport and NIE number (foreigner´s identity number) along to your local health centre. You can then register with a doctor and apply for a health card (tarjeta sanitaria individual or TSI). This will be sent to you in the post, or you will be asked to pick it up personally. The health centre will also be able to arrange for you to get a Sistema de Informacion Poblacional or SIP card. You´ll need to show it every time you visit a clinic, hospital or collect a prescription from a pharmacy.

European Health Insurance Card (EHIC)
If you have an EHIC card issued by an EU-member state and you are in Spain on a holiday or other temporary visit that is, you are not yet a resident in Spain  you can use your EHIC to access state healthcare in Spain. You can also use it if you are studying in Spain as part of a course based in your home country.
You can use the EHIC to get any medically necessary treatment (as determined by the doctor you see) through the state system either at a reduced cost or free. This could be routine or specialist treatment  for a new or an ongoing condition which cannot wait until you return home. It does not give access to private healthcare.
It is advisable not to totally rely on the EHIC and to take out medical insurance. There have been cases where an EHIC has been refused in some parts of Spain. This is being investigated by the European Commission but if it happens to you, try to get proof that you presented it at the time as it may persuade an insurer to waive their excess.

Hospitals
In an emergency you can go straight to a hospital A&E or ER (Urgencias).
If you want to get any other type of hospital treatment, you´ll need a referral from a doctor. There are public and private hospitals. Only the public hospitals provide free treatment. Some hospitals offer both private (privado) and state healthcare services (asistencia sanitaria publica), so make sure the staff knows which service you want.
When you go to hospital you´ll need to show your social security card or proof of private insurance.
If you are discharged from a hospital and need medication, you have to take the hospital medical report to a pharmacy for the prescription to be fulfilled, as hospital doctors don´t issue prescriptions.

Pharmacies in Spain
You can take a prescription to any pharmacy (farmacia). Look for a shop with a large green cross sign outside.
Pharmacy opening hours
Pharmacies are usually open Monday to Friday from 9.30am to 2pm and 5pm to 9.30pm, and Saturdays 9.30am to 2pm. There´s usually a notice on the pharmacy window or door with details of the nearest 24-hour pharmacy (farmacia de guardia) or you can find a list of pharmacies online.

Prescription charges in Spain
You have to pay a percentage of the cost of prescription medicines, and the cost is non-refundable. How much you pay depends on your income and whether you are of working age or a state pensioner. For example, if you are of working age and your annual income is less than EUR 18,000 you have to pay 40 percent of the cost of the medication. If your income is between EUR 18,000 and 100,000 you pay 50 percent, and if it´s over EUR 100,000 then you pay 60 percent. State pensioners pay 10 percent unless their income is over EUR 100,000, in which case they also pay 60 percent. You can find out more about this co-payment system, in Spanish, here.
Registered pharmacists can also provide health consultations and guidance on health matters.

Visiting the dentist in Spain
Dental treatment is not covered by the state healthcare system unless in an emergency. You must either pay for dental treatment unless you have private health insurance. Find a dentist by looking in the phone book or by personal recommendation. Just call up and make an appointment.

In an emergency
In a serious, life-threatening emergency, call the pan-European number 112 free of charge from any mobile/cell phone or landline. The Spanish word for A&E or ER is urgencias.

Other emergency numbers include:

060 for an ambulance (ambulancia) 961 496 199 emergency dentists 963 600 313 on duty pharmacy