Health insurance and medical care in Spain

In Spain, healthcare is guaranteed by the SNS, 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 EU, the EEA 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 descendants 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.

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 of primary health care centres and hospitals are available on the Ministry of Health, Social Services and Equality web page: 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 SNS, 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. Supplementarycommon 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 , 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.

Access to the services is via the individual health card (TSI) issued by each health service. This document identifies each citizen as a user of the SNS.

The format and content of the TSI, 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 EU, EEA or Switzerland citizens) may be submitted at any Social Security office.