For members


Paying for public healthcare in Spain: the pros and cons of the ‘convenio especial’

If you live in Spain but can't use the public health system as a result of not having social security, there is another way to access public healthcare. Find out if this ‘special agreement’ is right for you or if you're better off getting private healthcare.

Paying for public healthcare in Spain: the pros and cons of the 'convenio especial'
What are the advantages and disadvantages of Spain's convenio especial? (Photo by Nicolas TUCAT / AFP)

What is the convenio especial?

The convenio especial (which translates to ‘special agreement’) allows foreigners in Spain to pay a monthly sum into the country’s public health system to have access to it, even if they don’t have access to Spain’s social security system through work or a pension (a Spanish one or one that’s transferred from your home country such as the S1 scheme for British pensioners) . 

READ ALSO – Healthcare in Spain: the steps to apply for the S1 form for UK state pensioners

To access it, you will pay a monthly fee of €60 if you are under 65 and €157 if you are over 65. 

Spain’s public health system is widely regarded to be among the best in the world, but before you decide to opt for the convenio especial, consider the advantages and disadvantages that it will bring you as a foreigner in the country.

What are the pros of the convenio especial

  • You are able to access Spain’s public health care system
    As stated earlier, even if you’re not working or paying social security through self-employment in Spain, you will still be able to have access to public healthcare via this special agreement.

  • You will be fully covered by the public health care system
    Even if you have pre-existing conditions, you will be fully covered by the public system. This is especially good to know for those who may have particular conditions that will not be covered by private healthcare.

  • You won’t have to pay extra for certain procedures
    Certain medical procedures may not be covered by private health insurance and you will end up paying extra, but those on the convenio especial won’t have to. 

  • Pregnant women and children don’t have to apply
    If you’re pregnant or are a child, you are already automatically covered under the Spanish public health system for free, so will not have to sign up and pay for the convenio especial.

  • You are covered temporarily in other regions of Spain
    If you are temporarily in another Spanish region, such as for a holiday for example, then you will be covered for healthcare there too.

  • The convenio especial doesn’t have an expiry date
    You can pay for it as long as you need it, provided you don’t get a job or become self-employed, in which case you will be covered for national healthcare by paying social security instead.

What are the cons of the convenio especial

  • You must have been registered as legally living in Spain for one year
    To be eligible to apply for this agreement, you have to have been living in Spain for one year before you can access it. You will need to prove this via your padrón certificate.

  • Not everything is covered
    Prescriptions, prosthetics and dietary products are not covered under the convenio especial.

  • You can get private health care insurance for around the same price
    If you’re in good health and not in your twilight years, private healthcare can be very affordable in Spain, and you may be able to get coverage with some companies for a similar price as for the convenio especial. However, private healthcare companies won’t cover pre-existing conditions, so you may end up paying more in premiums.

  • Public healthcare waiting times are often much longer

If you need to have surgery in Spain, the average waiting time through public healthcare in 2022 is 123 days, whereas through the private system it can be a fraction of this (around 30 days). The same applies to seeing a specialist, although this depends on what type of doctor you have to see and what region of Spain you live in. All in all, whatever medical service you need, you can expect much longer waiting times through public healthcare in Spain. 

READ ALSO:  What are the best private health insurance options in Spain for Brits?

  • You will need a lot of paperwork
    Like many situations in Spain when applying for a document, you will require a lot of paperwork. One of these documents, which can sometimes be tricky to get, is a letter from your home country stating that you’re not covered for health care there anymore.

  • You will not have the right to get a European Health Card for travel
    If you’re only covered through the convenio especial, then you can’t apply for a European Health Card. This means that when you’re on holiday or travelling in the rest of the EU, you will need to take out private travel insurance instead.

READ ALSO – TSE card: How to get a Spanish European Health Insurance card

  • You will generally need a good level of Spanish
    You won’t find many doctors in the public healthcare system in Spain that have a good enough level of English to treat you in English. They may have a basic level, but most of them are not comfortable with giving you medical advice in English. This is true even in big cities like Barcelona. If you take out private healthcare, you’re much more likely to find a doctor who will be able to speak to you in English.

READ ALSO: What are the different types of medical specialists called in Spanish?

  • You will need to wait at least a month
    To find out if your application has been accepted, it will take at least a month. On the other hand, if you’re paying social security and you register with your local clinic, even though your health card may take a month to arrive, you will be registered and be able to make an appointment with a doctor straight away. 
  • If you move to a different region in Spain, you will have to re-apply 
    As with many processes in Spain the convenio especial differs slightly between regions, as does the way you apply for it. This means that if you move from Andalusia to Catalonia for example, you will have to re-apply. 

  • You will need to apply and pay for each member of the family separately
    Members of your family will not be covered under the convenio especial, even if you are. If you pay social security, however, and are covered for public healthcare that way, then the other members of your family who are dependent on you will be covered too.

  • If you opt-out of the convenio especial, you will not be able to sign up again straight away
    If you choose for whatever reason to stop paying for the coverage, then you will not be able to apply again until a whole year has passed. This means that you will probably need to get private health insurance while you wait to reapply. 

Member comments

Log in here to leave a comment.
Become a Member to leave a comment.
For members


What is the average waiting time across Spain to see a doctor?

Find out the average amount of time you'll have to wait to see your GP, a specialist and get a non-urgent surgery in your region of Spain.

What is the average waiting time across Spain to see a doctor?

Where you live in Spain greatly affects the amount of time you’ll have to wait, from the first appointment with your family doctor to seeing a specialist and even through to an operation, if you need one. 

Two and half years after the beginning of the Covid-19 pandemic, which almost brought the country’s clinics and hospitals to breaking point, how is the situation now?

Here are the average waiting times in each region of the country, with data published by the regional health authorities. 

In Andalusia, the average wait time to see a doctor is four days. To see a specialist such as a dermatologist or a cardiologist, however, you will be waiting three months. Wait times for non-urgent surgeries vary depending on what you need. 

Those living in Aragón will typically be able to get a doctor’s appointment within three days, but to see a specialist, it is one of the worst regions in the country, with an average waiting time of four months.

The latest waiting times to see a doctor or a specialist in Asturias have not yet been published, but if you need a special test such as an MRI, you will be waiting more than three months.

Balearic Islands
In the Balearics, the average waiting time for an appointment to see your GP is one week, while if you need to see a specialist, you will be waiting around two months. For a non-urgent surgery, you will be on the waiting list for an average of four and a half months. The Balearic Islands are one of the worst places if you need a diagnostic test though with an average wait of more than six months. 

Basque Country
Data from the Basque Country has so far not been made available. 

Canary Islands
Like in Aragón, the Canary Islands is one of the worst places to live if you need to see a specialist with the longest waiting time of more than four months.

Cantabria has so far not updated its data on waiting times to see a specialist, but if you need a non-urgent surgery it has one of the longest waiting times at six months.

Those in Castilla-La-Mancha have one of the shortest wait times to see a GP, being able to book an appointment within just 48 hours. They’ll have to wait longer to see a specialist, however, with an average wait of two months. Those waiting for non-urgent surgery will be waiting another four months.

Castilla y León
In Castilla y León you’ll wait an average of six days before being given an appointment and two months to see a specialist.

Residents of Spain’s northeastern region wait an average of five days in order to get a doctor’s appointment. For diagnostic tests, the wait time depends on what you need. You will be on the list for five months on average for a colonoscopy and two months for an MRI.

If you need to see a specialist again it will completely depend on what type of specialist you need to see. For example, if you need to see a urologist you’ll have to wait five months, but if you need to see a neurologist you’ll be able to get an appointment in less than three months. If your doctor thinks you require non-urgent surgery, you will need to wait another four and half months.

In Extremadura, you’ll have to wait an average of four days for an appointment, while the waiting time to see a specialist will be around two months. Like Cantabria, Extremadura is one of the worst places to live if you need non-urgent surgery, as you’ll be waiting around half a year.

Those in Galicia will be able to see a doctor in just three days, however, they have not published recent data on the wait time to see a specialist. They have however published data for non-urgent surgery which is an average wait of three months.

Like in Galicia, in Madrid the waiting time for an appointment is just three days, but two months to see a specialist. For a test like an ultrasound or a CT scan, you will be waiting two months. If you need a non-urgent surgery, you’ll be on the waitlist for a further three months.

The average wait time to see your GP has not been made available yet, but like in Andalusia, you’ll be waiting more than three months if you need to see a specialist. It’s one of the best regions for wait times for diagnostic tests though as you will be waiting less than one month. 

Navarre has one of the shortest wait times for an appointment, available in just 48 hours. If you need to see a specialist, you’ll be waiting a further two months. Those waiting for a non-urgent surgery will have to wait an average of three months.  

La Rioja
Along with Castilla-La Mancha and Navarre, La Rioja has the shortest wait time to get a doctor’s appointment. Here, you’ll be able to see your GP in just 48 hours. This region is also the best to live in if you need to see a specialist or get a specialised test, with a wait of less than one month. If you need non-urgent surgery though it’s not so good, as you’ll be waiting an average of four months.

Those living in Valencia have the longest wait out of all the regions for an appointment, where you’ll wait more than a month just to see a GP. When it comes to seeing a specialist you’ll need to wait another three months. And if you need surgery, you will have to wait four and half months on top of that.

The types of non-urgent surgeries the data refers to are hip and knee replacements. For other types of surgeries, it will depend on how urgent it is and what type of surgery it is. At the beginning of the year, there were more than 706,000 people waiting for an operation in Spain, according to data from the Ministry of Health.

You should be aware, however, that official data doesn’t always represent reality. Some readers have told us that currently, they are having to wait a month to see their GP in Catalonia and seven months to see a specialist.