The Healthcare System in Spain: Access, Coverage and Procedures in the Autonomous Communities

Healthcare is a fundamental right in Spain, and its healthcare system is known to be universal and of high quality. In this article, we will explore in detail how the right to healthcare works in Spain, the different methods of obtaining healthcare coverage, how family members are added as beneficiaries, and the requirements for having a general practitioner and a healthcare card in each of Spain’s autonomous communities.

The Right to Healthcare in Spain

The healthcare system in Spain is based on the principle of universality, which means that all residents are entitled to medical care, regardless of their nationality or employment status. Below is a description of the different groups that have access to healthcare in Spain:

1. Workers who pay Social Security contributions:

Workers who are employed and contribute to the Spanish Social Security system are automatically entitled to healthcare. This includes Spanish citizens and foreign workers who are legally resident and working in Spain.

2. Foreigners with European Document S1:

EU citizens who move to Spain and receive a pension or benefit from another EU Member State can obtain health coverage through the European S1 document. This document allows them to access health services in Spain free of charge.

3. People without financial resources:

Even if they are not employed and do not pay Social Security contributions, people without financial resources are also entitled to health care in Spain. They can apply for health care in their autonomous community and, depending on their situation, they will be assigned a health centre or hospital to receive medical care.

Add Family Members as Beneficiaries

If you are the holder of health care in Spain, you have the option of adding your spouse or unmarried partner, as well as your children under the age of 26, as beneficiaries. The process to do so usually requires the following documents:

– Certificate of domestic partnership or family record book for spouses.

– Birth certificate or family record book for children.

Once they have been added as beneficiaries, they will be entitled to health care under the same conditions as the holder.

Assignment of General Practitioner

In Spain, the assignment of a family doctor is generally done through the following steps:

– Registration (“Empadronamiento”): You must be registered in the municipality where you live. This will allow you to access primary health care services.

– Health Centre: You must then go to the nearest health centre and ask to be assigned a family doctor. You will usually be assigned a doctor who works at that centre.

Change of doctor: If you wish to change your general practitioner, you can apply at your health centre. Common reasons include change of residence or personal preference.

Obtaining the Health Insurance Card in Autonomous Communities

Spain’s autonomous communities may have slightly different procedures for obtaining the Tarjeta Sanitaria Individual (TSI). The general procedures in some of the larger autonomous communities are described below:

– Community of Madrid: You must go to the Centro de Atención al Usuario (CAU) with your NIE (Número de Identificación de Extranjero) and empadronamiento to obtain your TSI.

– Catalonia: Make an appointment at the nearest CAP (Centre d’Atenció Primària) with your NIE and census registration number to obtain your TSI.

– Andalusia: Go to the health centre with your NIE and census registration number. There, you will be assigned a family doctor and you will be given your TSI.

– Comunidad Valenciana: Apply for your TSI at the Health Centre with your NIE and empadronamiento. You will be assigned a family doctor in the process.

It is essential to check the specific procedures in your autonomous community, as they may vary slightly.


The health care system in Spain is one of the most advanced and accessible in the world. All residents, including workers paying Social Security contributions and EU citizens with the European S1 document, are entitled to health care. Adding family members as beneficiaries, assigning a family doctor and obtaining a health card are essential steps to accessing health services in Spain, and these processes may vary depending on which autonomous community you are in. It is always advisable to check with your local authorities or nearest health centre for up-to-date information on the specific procedures and requirements in your area.

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