Public healthcare in Spain – how it works

Doctors smiling
nice doctors 🙂


It’s human nature:

We get sick.

And if we -or our children- get sick, and by that, I mean…

  • A cough that lasts more than a week or is very sore.
  • Or if the child gets a high fever that won’t break.
  • Or an upset tummy becomes a bad case of diarrhoea.
  • Or your kid won’t stop getting sick.
  • Or a weird rash suddenly appears.
  • Or you or any of your family members start feeling very tired without any apparent or logical reason for it.
  • Or (insert here your biggest inner fear).

We go to the doctor.

But we also want a good doctor.

Not anyone, but a good, trusted one.

This is something we take for granted in our home country, or somewhere we’ve lived in a long time:

We already know where and to whom to go to.

We know we’re going to be in good hands.

But what if we move?

Where do you bring your child?

Where do you go yourself?

And often the question arises:

Do we go public?

Is the public health system good?

Or do we go private?

It’s a valid question for all expats, because the company that is sending you away for a few years will most probably offer the private insurance as part of your expat salary package.

But is it always the best option?

If you come from Latin America, you won’t hesitate going to the private doctors, because we don’t have a good track record of public health systems in our countries, and it’s in our DNA to mistrust it.

But you will soon find out that it is not the case in Spain.

If you come from Europe, this question won’t always be an issue for you.

However, we always ask ourselves if the person who will make us feel well again is competent or not.

So, let’s dive in into the…

Public Healthcare System or Sanidad PĂşblica

AtenciĂłn Primaria or Primary Care

Like every other good European welfare State, Spain has it’s own healthcare system.

La Sanidad PĂşblica.

One of the prides of the Spanish State and people.

Funded by taxes, the first point of contact for everything is your local Centro de Salud.

This Centro is assigned to you based on where you live, and each Centro has about 10,000 – 25,000 assigned patients (not that all of them go there.)

The focus of all Centros de Salud is the AtenciĂłn Primaria (Primary Attention).

Atención Primaria is no other thing than your first point of contact for all health related matters (colds, fevers, checkups, vaccines, …).

This means that they all should have the following services:

  • GP’s (MĂ©dico de Familia)
  • Peadiatricians (Pediatras)
  • Nurses (Enfermera)

And some of them will also have some or all of the following services: 

(Please check with your local centre if they have these services)

  • Laboratory for sample taking (laboratorio)
  • Physiotherapy (Fisioterapia)
  • Midwife (matrona)
  • A&E (urgencias)

Basically, this is where you go if you don’t know what’s up with you or your kid, it’s a weekday, if you want your medication toped up or need a shot of some kind (not tequila, sorry).

Some Centros de Salud will also look at you if you have an emergency and you don’t have an appointment.

Yes, they work by appointment.

Which you can get by phone, online or through their app, which works very well, by the way.

(You can download the app on Google Play or App Store)

So, once you’ve gone to your GP or Peadiatrician and they think your case needs a specialist, they will refer you to one within the public system.

Especialistas or Specialists

Once your doctor has referred you to a Specialist, you will need to make an appointment to see them.

There are three options:

  1. Your doctor will give you a reference number and with that you can make the appointment via the app yourself. You can choose the hospital you’d prefer to go to, as well. 
  2. Someone will call you and will give you the appointment (in Spanish).
  3. You will be sent a letter with the date and time of your appointment, as well as the hospital you need to go to.

I need to add something here:

As with many systems in Europe, the waiting times can be potentially lengthy if the case is not deemed urgent by your doctor.

3 months.

4 months.


At the time of this update (March 2024), I got a 12 month waiting time for a bone densiometry. In fairness, the doctor said he didn’t see it as urgent, because my previous ones had been ok. If he had seen any urgency, I’d had gotten the appointment quicker.

But if your doctor sees any kind of urgency, they will see you pretty much straight away.

It happened to my cousin. She called me in a mild panic (who wouldn’t?) because she found a lump in her breast. I told her to go to her Centro de Salud straight away, without an appointment, and she was seen that same afternoon.

(Thankfully it was nothing.)

You have your appointment, now what?

You need to bring your Tarjeta Sanitaria and the document your GP gave you to said appointment.

In that document is your medical history and a brief explanation of why you’re being referred for.

The specialist will make an assessment, ask questions (normally in Spanish) and open your file in that hospital.

That way you are officially in the system.

If you need more tests or a follow ups, they will remind you and schedule the appointments themselves.

Does the system work?

Yes, it does.

Is it perfect?

There’s room for improvement on the managment side of things, but overall I have found that doctors and nurses are very competent, good, most are very nice, and they do care about their patients.




This article has taken longer than I expected and that’s why I´m going to leave it here, but I will write about the private healthcare system in two weeks.

(At the time of this update, that article is already published. You can find it here.)

And I will also explain how you can use both systems to always be in the best hands.

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