At a Glance: Spanish Healthcare
| System Name | Sistema Nacional de Salud (SNS) |
|---|---|
| Management | Decentralized (Managed by 17 Autonomous Communities) |
| Key Requirement | Social Security Number & Empadronamiento |
| Card Name | Tarjeta Sanitaria Individual (TSI) / SIP |
| Coverage | Free Doctors/Hospitals, Subsidized Medicine |
| Emergency Number | 112 (General), 061 (Medical) |
Spain's Sistema Nacional de Salud (SNS) is renowned for its high quality and accessibility. It is a universal system funded by social security contributions and taxes.
However, the system is decentralized. This means the rules, the look of the health card, and even the digital apps vary depending on where you live (e.g., CatSalut in Catalonia, SERMAS in Madrid, SAS in Andalucia). Despite these regional differences, the core benefits remain the same across the country.
Who is Entitled to Free Healthcare?
Access is not automatically given just because you are in Spain. You generally qualify if you:
- Are employed or self-employed (Autónomo) and pay Social Security contributions.
- Receive certain state benefits or a pension.
- Are a dependent (spouse/child) of a covered person.
- Are an EU/EEA citizen with an EHIC card (for temporary stays).
- Are a pregnant woman (regardless of residency status).
The Golden Key: Empadronamiento
Crucial Step: You cannot get a health card without the "Padron".
The Empadronamiento is the process of registering your address with the local town hall (Ayuntamiento). It proves you live in that specific municipality.
How to get it:
1. Go to your local Ayuntamiento (appointment usually needed).
2. Show your Passport/NIE.
3. Show proof of address (Rental contract or utility bill).
4. You will receive a Certificado de Empadronamiento. Keep this safe!
Step-by-Step: Getting Your Tarjeta Sanitaria (TSI)
Once you have your Social Security Number and Padron, you can apply for your health card (often called SIP card in Alicante/Valencia or CAP card in Catalonia).
Step 1: Social Security
Ensure you are registered with the Tesorería General de la Seguridad Social (TGSS) and have a number.
Step 2: Find your Centro de Salud
Identify the "Centro de Salud" (Primary Health Center) assigned to your address. You can find this on your regional health authority website.
Step 3: Application
Visit the center with your SS Number, Padron Certificate, and ID (TIE/Passport). Fill out the application form.
Step 4: The Card
They will often give you a temporary paper document (which works immediately). The plastic card will arrive by post in a few weeks.
Pharmacy Co-Payment Tiers (TSI Codes)
Unlike doctor visits, medicines are not 100% free. The amount you pay depends on your income and is indicated by a TSI Code (Tipo de Usuario) on your prescription.
| Code | Status / Income | You Pay |
|---|---|---|
| TSI 001 | Non-contributory pension / Social exclusion | 0% (Free) |
| TSI 002 | Pensioners (Income < €18k) | 10% (Capped at ~€8/month) |
| TSI 003 | Active Workers (Income < €18k) | 40% |
| TSI 004 | Active Workers (Income €18k - €100k) | 50% |
| TSI 005 | High Income (> €100k) | 60% |
Emergency Care (Urgencias)
If you have a serious medical emergency, go straight to the nearest hospital's Urgencias department.
- Public Hospitals: Treat everyone. If you have a TSI card, it's free. If you don't (and are not a tourist with travel insurance), you may be billed later.
- Wait Times: Can be long for non-life-threatening issues (Triage system: Red is immediate, Green is wait).
- Important: Do not use Urgencias for routine prescriptions or mild colds; go to your Centro de Salud or an Urgencias de Atención Primaria (PAC).
Find a Hospital or Health Center
Since the system is regional, finding the right portal can be tricky. The Ministry of Health provides a central search tool.
Search Ministry of Health Directory
Locate Hospitals, Centros de Salud (Primary Care), and Pharmacies officially recognized by the SNS.
Official Facility Search →Emergency Ambulance: 112