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Do all foreigners in Spain have access to free public healthcare?

The Local Spain
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Do all foreigners in Spain have access to free public healthcare?
Is public healthcare free for everyone in Spain? (Photo by SEBASTIEN BOZON / AFP)

There's always been a lot of confusion regarding whether public healthcare in Spain is free for all and whether those who aren't officially residents can get treatment. The Spanish Health Ministry has made a move to clear this up.

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Most people are aware that Spain has a free public healthcare system and many automatically assume that everyone who moves here will have access to it.

This is not necessarily true, however, and the rules are a little more complicated than that.

According to Spanish Law (Ley Orgánica 4/2000, de 11 de enero), all foreigners in Spain (legally resident or undocumented) have the right to public healthcare in Spain. 

On the other hand, General Health Law (14/1986 of April 25, Article 1.2) states that All Spaniards and foreign citizens who have established their residence in the national territory are entitled to the right to health protection and health care.

The second refers only to those who have legal residency here, so not including undocumented migrants and other non-residents.

If you do legally move here and are a third-country national from the UK or the US for example, you will only be able to register with a public doctor for the first five years initially if you are:

  • Employed or self-employed and therefore paying social security contributions.
  • Able to register a social security exchange form that grants you the right to public healthcare in Spain (such as the S1 form for Brits in Spain).
  • Paying into the convenio especial social security scheme that gives access to public healthcare after one year living in Spain.

Many of these conditions will be part of being granted your visa or residency permit.

After getting permanent residency after five years, you will theoretically have access to public healthcare without the need to pay for it.

But this is also confusing as previously many people have reported on forums such as Citizens Advice Bureau that some regions won’t allow you to register with a doctor without proving that you pay social security.

READ ALSO: Does permanent residency in Spain equal free public healthcare?

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Recently Spain's Ministry of Health made a move to clear up the confusion in the laws, as well as access for undocumented migrants.

In 2012, the ruling party at the time, the PP approved a law in order to exclude migrants without legal residency from accessing public healthcare.

But on Tuesday May 14th 2024, this all changed when the Spanish cabinet approved a draft bill aimed at recovering the "universality of the healthcare system", so that all people living in Spain, regardless of their administrative status, may be treated in health centres, without being denied assistance or later receiving an invoice demanding payment.

The decision comes a few months after the controversy generated by the mayor of the town of Ripoll in Catalonia, Sílvia Orriols. Orriols restricted migrants from registering, making it difficult for them to get a health card and see a doctor.

The law was modified in 2018 to allow those without papers to submit a report to social services, but in reality, many were denied from doing this or were forced to wait for months.

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"We want to close that wound" and, in moments of "exclusionary discourses", harness healthcare universality "as a tool to have more cohesive, efficient and fair societies”, Health Minister Mónica García explained.

READ ALSO: Spain's plan to stop the privatisation of public healthcare

The new draft rule states that foreigners not registered or authorised as residents in Spain must only sign a responsible declaration, "with which they will never be denied healthcare," according to the minister.

The law also aims to guarantee healthcare to Spaniards residing abroad and their family members, as well as the children of foreigners residing in Spain who agree to reunification, provided that there is no third party who is obliged to pay for care.

The bill also aims to reduce co-payments, so that all the groups mentioned above will not have to pay 100 percent of their medications either, but it’s unclear yet or not whether this will go through.

The draft law will now need to be studied by both advisory bodies and the government, so it will not be published in the Official State Gazette and come into force for several months or even years.

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