The health system in Spain

Two parallel health systems operate in Spain:

1. Public health
2. Private healthcare

Both have their own infrastructure (primary care centres, hospitals, home care, residential homes, etc.), although in some situations they may collaborate with each other.

Public health

It is managed by the INSS (National Social Security Institute).
All persons with a Spanish Health Insurance Card (SIP) or a European Health Insurance Card (EHIC) from a country with an agreement with Spain are entitled to care. In the case of the EHIC, it only covers emergency medical care.

Private healthcare

You can access it in several ways:

• Through travel insurance,
• With a foreign health insurance with international coverage,
• Or through a Spanish private health insurance,
• And, of course, by paying directly for the services.

Tourists

For tourists residing outside the European Community, it is recommended to take out travel insurance.
Be sure to read the terms and conditions of your policy carefully.

For those who have the European Health Insurance Card (EHIC), you can go to any public health centre in Spain. Coverage is limited to emergency medical care.

Additional travel insurance is recommended, as it usually includes repatriation and the possibility of going to private health care, where there are usually fewer language barriers and more personalised care.

Long-term residents (non-residents)

They are those who live part of the year in Spain, often with a property here, but are resident in another country.

With the EHIC they can access the Spanish public health system, but only for urgent medical care.
For convenience or to have access to private health care, many opt for private health insurance (Spanish or with international coverage).

Travel insurance can also cover medical care for short stays (usually up to 90 days).

Since 2006, residents of the Netherlands can receive private care under the same conditions as in the Netherlands, although they must submit bills to their insurer.
Some clinics, such as Clinica Benidorm or IMED, bill Dutch insurers directly, provided that the patient has a referral from a general practitioner. 

Residents

For those who live and work in Spain, most of them contribute to the state system (directly or indirectly) and can use the Spanish public health system. You have full access to the National Health System (SNS) with your SIP card. However, a large proportion of residents also (and some exclusively) have private insurance. You can read below what you should consider when taking out private health insurance.

Since 2006, most Dutch pensioners and beneficiaries resident in Spain are obliged to contribute through the Dutch system and are thus covered by the Spanish social security system.

Public or private healthcare?

The two systems complement each other.
Public health care sometimes refers patients to the private sector to reduce waiting lists or to facilitate care for foreigners.
On the other hand, some treatments are only available through Social Security.

Many patients - both Spanish and foreign - choose private healthcare because of advantages such as:

• Shorter waiting time,
• Choice of doctor or specialist,
• Single rooms,
• More personalised and faster treatment.

Private health insurance

Choosing private health insurance is not easy: there are many different options and conditions.
Here are some practical tips:

1. Assess whether you really need private insurance.
   If you only want it for minor issues and you have savings, you may not need it.
2. Read the coverage carefully.
   Some cheap insurance does not cover medicines, prostheses or certain treatments.
3. Don't get carried away by price alone.
   Sometimes, by paying a little more, you get much better coverage.
4. Choose a solid insurer.
   Small and regional ones are more vulnerable.
5. Please note the age limit.
   Most do not accept new customers over a certain age.
6. If you have had major illnesses, you may be excluded from certain coverages.

Types of private insurance

1. Foreign insurance with coverage in Spain.
2. Reimbursement insurance ("reimbursement" or "restitution").
   You can choose any doctor or hospital, pay and then get reimbursed between 80% and 100%.
3. Insurance with a "medical panel".
   You can only go to doctors and hospitals within the network.
4. Mixed insurance.
   They combine both options: you can use the network or go outside and receive a partial reimbursement.

Reimbursement insurance offers more freedom, but tends to be more expensive and requires advance payment. The mixed option is often the most practical and flexible.

Recommendation

• Request several quotes and compare them.
• Keep in mind that each agent works with different insurers and, in addition, many insurers have several products.
• Check your local medical directory.
• Compare the conditions (the "fine print") before you decide.
• Once you have made your choice, you can consult with Dr. Meertens to find out how the insurer works in practice.

Examples of insurers with coverage for private care

Reimbursement or mixed:

• Catalana Occidente Universal Gold
• Plus Ultra (formerly Groupama)
• Saint Lucia Reimbursement
• Generali Health Choice
• Cigna Health Reimbursement
• Sanitas Health Plan (Complete)
• DKV Mundi Health
• AXA Optima Plus
• Asefa Health TOP
• Caser Prestige
• Mapfre Medisalud
• Allianz (Reimbursement/Mixed)

Medical insurance (these insurances have contracted in our clinic only medical care from family doctors; before taking out insurance, always confirm with our reception if we continue to work with them!)

• Sanitas Health Plan (please note, only this plan)
• DKV Integral
• Salus
• ASSSA Master

We have not included foreign insurance, it would be impossible, but they are definitely options to consider.

If you wish, you can download a comparison list in PDF or Excel (in Spanish/Dutch or Spanish/English) to help you compare insurances:

conditions in Dutch-Spanish

conditions in Spanish-English