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The Spanish Healthcare System

Spain enjoys a national healthcare system that provides health services to all Spanish residents. Since the system is based on universal healthcare, non-residents and tourists (and even people living in the country illegally) are never denied treatment. Sometimes non-resident patients are charged (either directly or via their national social security system) for treatment, although this is often not the case with basic services.

Tourists from EU countries can receive free treatment in Spain for up to three months, after which a European Health Insurance Card (EHIC) is necessary. The EHIC replaces the E111 form, which is no longer valid.

Foreign expatriates in Spain are entitled to free public healthcare as long as they contribute to the social security system, since anyone who signs up to pay social security is automatically registered as a member of the public healthcare system (family members are also entitled to healthcare by extension).

Additionally, Spain has agreements in place with certain countries (such as the UK) that allows foreign pensioners to receive free access to public healthcare without having to participate in the workforce.

UK pensioners, for example, should obtain an E121 form from the UK's Department of Social Security and register this form at their local social security office in Spain. For more information on receiving access to Spanish public healthcare as an expatriate pensioner, contact your country's social security department.

While Spain's healthcare system is recognized as one of the best public health programs in the world, it also has its flaws. Most people in Spain who can afford to purchase private healthcare choose this option.

The preference for paid, private healthcare is not caused by a lack in quality of the public system but mainly due to the long waiting periods patients are often faced with. Private healthcare companies can offer quick attention, while the waiting time at public facilities can often be one of weeks or months (excluding emergency care, which is immediate).

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The Spanish National Healthcare System
Spain's national healthcare system (“Instituto Nacional de la Salud”) covers 100% of the Spanish nationals, regardless of economic situation or participation in the social security network. As mentioned above, non-nationals who participate in the social security system – and their family members – are also covered by public healthcare.

The national healthcare system is decentralized in order to provide greater and equal access to the population, thus avoiding the concentration of health services in urban areas. Recent reforms have regionalized the system to provide improved response time and increase the participation of the target community in the development and management of the national healthcare system at regional and local levels.

The system consists of three organizational levels:
1. Central (Organizacion de la Administracion Central)
The state's central administration agency is the Ministry of Health (“Ministerio de Sanidad y Consumo”). This agency is in charge of issuing health proposals, planning and carrying out the execution of the government's health guidelines, and coordinating the activities aimed at reducing the consumption of illegal drugs.

2. Autonomous Community (Organizacion Autonomica)
The territorial administration of health services is the responsibility of each of Spain's 17 Autonomous Communities (“Comunidades Autonomas”). Each Autonomous Community must offer integrated health services to the population through the centers, services and establishments of that community.

3. Local (Areas de Salud)
The “areas de salud” are the fundamental structures of the national healthcare system and are responsible for the unitary management of the health services offered at the level of the Autonomous Community.

The “areas de salud” are defined taking into account factors of demography (with a minimum of one “area de salud” per region), geography, climate, socioeconomics, employment, epidemiology and culture. To increase operability and efficiency, the “areas de salud” are subdivided into smaller units called “zonas basicas de salud”.

Private Healthcare in Spain
Care at private hospitals and clinics in Spain is either paid directly or, most often, through a private insurance carrier. The main benefit of contracting private health insurance in Spain is to avoid the sometimes long wait times to see a doctor associated with the public healthcare system.

Private healthcare companies also offer quicker service to patients and offer value-added services such as private rooms, express mailing of test results and keeping patients informed via email and SMS messages.

Some of the most popular private medical insurance carriers are Sanitas (www.sanitas.es) and Mapfre (www.mapfre.com).


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