How the public and private systems work
In Spain, there are a parallel public health care system and a network of private health insurance companies. Some Spaniards choose a private insurance as a supplement to the public system.
Public health care
Until recently Spain provided universal health care to all of its citizens under a tax-financed scheme run by INGESA (Instituto Nacional de Gestión Sanitaria), part of the Ministry of Health and Social Policy (Ministerio de Sanidad, Servicios Sociales y Igualdad). The management of these services has now been decentralised and transferred to the distinct autonomous regions (comunidades autonomas) with corresponding powers and responsibilities.
Communication between the regional government bodies and the Ministry is aided by the Interterritorial Council of the Spanish National Health Service (Consejo Interterritorial del Servicio Nacional de Salud de España, CISNS) which gives cohesion to the system and aims to guarantee the rights of residents throughout Spain.
Public health care provision may therefore vary slightly depending on the autonomous region you reside in.
Over 90% of the population in Spain makes use of the public system for their medical needs. The most frequent model allows Spaniards to choose their primary care doctor (GP), through which they access the rest of the system. In order to consult a specialist, patients must first be referred by their primary care doctor (except in emergencies). Nevertheless, regional health services are increasingly integrating primary care and specialist care. Since medical care is covered by the state, there should usually be no out-of-pocket expenses. However, it should be noted that dental and eye care tend to be covered privately.
Unfortunately, as in some European countries there can be long waiting lists to see specialists and for elective and non-emergency surgical care.
Private health care
An estimated 18% of the population holds private health insurance including most civil servants who have the choice of coverage by the public or the private systems. This insurance is used either as a supplement or an alternative to public care.
The advantage of private insurance is that the companies have their own network of hospitals, clinics and laboratories. Policyholders usually do not have to wait as long for treatment. The only downside is that these companies can insist that patients use only doctors who are members of their group. However, some have programs that refund 80% of the fees charged by physicians outside the group. Adeslas, Asisa and Sanitas are the largest private healthcare providers