Healthcare in Spain

private health care

Quality Spanish Healthcare

According to the prestigious scientific journal The Lancet, Spain has dropped from eighth position to 19th in 2017 and now receives 92 points out of the available 100. In the composition of the annual ranking, the health systems in 195 countries were examined. The reasons for the decline in the ranking are due to various causes: in the decline not only have the cutbacks of recent years influenced, but also that The Lancet now included more variables to determine the score.

Iceland and Norway stand at 97 points at the top of the list of The Lancet with 97 points. They are followed by 96, the Netherlands, Luxembourg, Australia, Finland and Switzerland. The Top 10 is closed by Sweden, Italy and Andorra with 95 points. Spain has 92 points with New Zealand, Denmark, Germany and France.

The Spanish health system is highlighted in a number of aspects, such as health care for tetanus, diabetes, appendicitis, diphtheria or epilepsy. In contrast, The Lancet sees shortcomings in the treatment of some types of cancer, especially skin cancer (57 out of 100 points), the uterus (60 points), the Hodgkin’s lymphoma and the testicle (79 points).

On an annual basis, Spain spends € 2,788 per year on medical expenses, which is below the average of € 3,436, the Netherlands € 4,622 and Belgium € 4,154.


Working with a contract and self-employers

If you have found a job in Spain you have free access to public health care and also if you have decided to start a business as a self-employed person. You must, however, apply for a “health insurance pass” or “tarjeta sanitaria” at a medical center (“Centro de Salud”). You will also be assigned a doctor with the application.



If you establish yourself as a pensioner in Spain, you are entitled to have access to public health care. You need to fill in the S1 form in the UK. This proves that you are entitled to healthcare if you do not live in the country where you are insured. Useful for posted workers, front-line workers, pensioners, civil servants.

The benefit or pension institution will deduct a so-called Health Insurance Act contribution (also called premium replacement or foreign contribution) from your benefit or pension.

You need the form E106 / S1 if you:

  • long-term work in another country than where you live;
  • long-term residence in another country than where you are insured.


How do I request Form E106 / S1?

You can apply for the form at the Care Institute in the UK. After they have received this application and checked it at your benefit or pension institution, this institute sends out the treaty form 121. This is how you register with the health care system (Seguridad Social) in Spain.

We look at two situations:

  • Retirement
    You receive a pension from Spain. In this situation you and your family are covered by the insurance system of Spain, regardless of whether you also receive a pension from the UK or other countries.
  • You will receive a pension from the UK. You fall under the English healthcare system, but you can make use of the facilities in Spain.
    You must request the right to health care from your insurer in the country where you are covered by the healthcare system via an S1 form (E121).


Seguridad Social

After your application has been processed, it will take a few weeks to a maximum of two months before you receive a letter from the INSS stating that you are entitled to medical assistance.

With this letter and a copy of this you go to the nearest ‘Centro de Salud’, a kind of extensive GP station in your place of residence. You will have to bring your residency certificate and your passport and of course copies of it.


Insurance pass

If all documentation is correct, you will be registered at this clinic from that moment on. You will receive a letter with which you can prove this if you need medical care before the insurance card has arrived. Here, too, a few weeks can pass.


How do I make an appointment at the “Centro de Salud”?

In Andalusia you can easily make an appointment with the doctor via the internet, by going to this link.

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