Confused about the Spanish healthcare system? Compare public vs private healthcare in Spain. Learn about access, quality, costs, wait times, and expat options.
Public vs Private Healthcare in Spain
What’s the difference, and which system is better for expats?
Spain has one of the best public healthcare systems in the world — but many residents still choose to pay for private coverage.
If you’re moving to Spain or applying for a visa, understanding the difference between public and private healthcare in Spain is essential. From access and wait times to English-speaking doctors and what’s covered, this guide walks you through the key differences — and why many expats use both.
The Spanish Healthcare System at a Glance
Spain has a dual healthcare system:
- Public Healthcare (Seguridad Social):
Funded by social security contributions, it provides universal access to citizens and legal residents who are employed, self-employed, or contributing voluntarily.
2. Private Healthcare:
Paid for out-of-pocket or through private health insurance, it offers access to private hospitals, clinics, and specialists — often with shorter wait times and more language support.
Who Qualifies for Public Healthcare?
You may be eligible for Spain’s public health system if you are:
- Employed or self-employed in Spain
- A registered pensioner with an S1 form (e.g. from the UK)
- A legal resident who has paid into social security
- A beneficiary (e.g., spouse or child of someone paying in)
You’ll typically need to register with your local INSS office, then obtain a health card (tarjeta sanitaria).
Why Do People Still Use Private Healthcare?
Even with public access, many residents (Spanish and foreign) choose to also have private health insurance in Spain.
Here’s why:
| Benefit | Public | Private |
| Cost | Free or low cost | Paid monthly premium |
| Wait Times | Can be long for non-urgent care | Usually much shorter |
| Doctor Choice | Limited by region/system | You choose doctors & clinics |
| Language | Spanish or Catalan only | English-speaking doctors available |
| Dental | Not included | Often available as an add-on |
| Direct Specialist Access | No (referral required) | Yes, in most plans |
Can You Use Both Systems?
Yes — and many people do.
This is known as mixed care. For routine needs, you might use the public system. But if you want faster diagnostics, a private hospital stay, or English-speaking support, your private insurance plan fills in the gaps.
If you’re new to Spain or awaiting public system registration, private insurance also ensures immediate access to care.
Do You Need Private Health Insurance for a Visa?
Yes — in most cases. If you’re applying for a:
- Non-lucrative visa
- Digital nomad visa
- Student visa (non-EU)
- Initial residency permit
…you are legally required to show proof of residency-compliant private health insurance (with no co-payments and full coverage). The public system alone won’t be enough — especially if you’re applying from abroad.
Check out our full guide to Health Insurance Requirements for Spanish Residency for details.
How Much Does Private Healthcare Cost in Spain?
Without insurance, a private consultation might cost €50–€100. Hospital stays and surgeries can run into the thousands.
However, private health insurance policies in Spain are much more affordable than in many other countries. Most expats pay €50–€120 per month, depending on age and coverage level. See our full cost breakdown for real examples.
Which One Should You Use?
It depends on your situation:
- Here for less than 12 months? → You’ll need private coverage.
- Applying for a visa? → Private is legally required.
- Retired or working in Spain long-term? → Use public, consider private for speed.
- Have a family? → Many choose private insurance for children’s care and maternity services.
- Want English-speaking doctors? → Private plans offer better access.
Need help understanding coverage options? Read What Does Private Health Insurance in Spain Cover? to compare.
Final Word
Spain’s public system is strong — but it’s not perfect, and it’s not instantly available to everyone. That’s why millions of people in Spain use private health insurance, whether required by law or chosen for convenience.
Still unsure? Start by learning What Private Health Insurance Is or explore Who Needs It based on your visa or residency type.