How does Spain's healthcare system compare with the US?

If you're an American looking to move to Spain, healthcare may be one of the main factors you look at when making your decision.

It's true that the system in Spain is very different to the US and that can have both its advantages and disadvantages. Here are some of the main differences and points to keep in mind. 

Public vs private

The main difference between healthcare in Spain and the US is that healthcare in the US is mostly private. The US health system does not provide universal healthcare for all its citizens. Most people are covered through private insurance and several federal and state plans.

In Spain, however, there is a public healthcare system. It’s not completely universal, because you have to be paying into the social security system in order to benefit from it, but it’s free if you are, and if you had a real health emergency, the system would not refuse to treat you.

Those who are Spanish pensioners, recipients of social security benefits and the unemployed can also benefit from the public healthcare system in Spain.

All pregnant women and children will also be treated for free under the public system, regardless of whether they or their parents pay into the social security system.

In Spain, healthcare is seen as a fundamental right and how much money you have won't determine whether you get treatment or not, whereas in the US healthcare is generally only available only to those who can afford it.

This means that a situation like in the hit US series Breaking Bad, where someone has to turn to illegal practices in order to afford their medical bills, just wouldn’t happen in Spain.

Having said that, According to data from UNESPA (the Employers' Association for Insurers), more than 11.5 million Spaniards have some type of private health insurance.

People may opt for private insurance if they’re not paying social security, but also it offers them several benefits over the public system such as shorter waiting times, direct access to specialists and second opinions.

READ ALSO: The best private healthcare for foreigners in Spain

Employer versus individual

Most US residents who are employed get their health insurance through their companies. Even then, not everything is covered and you may still have to pay some of your treatment out of pocket. In Spain on the other hand, most of the time if you want private healthcare, you will be responsible for purchasing your own policies from one of the dozens of insurance providers.

The cost of private healthcare is also much for affordable in Spain than in the US though. For example, most policies cost around €50 to €200 per month. If you opt for one without co-payments, which can cost around €80 per month, all your costs are covered, including emergencies and hospitalisations.

In certain situations, however, these private policies in the US that citizens receive through their employers can offer more than equivalent private insurance policies in Spain. For example, in the US some insurers will cover fertility treatments such as IVF. In Spain, there are very few that will cover this service completely, but they may offer a discount of 10 percent for example.

Keep in mind, if you have to pay privately for fertility treatments, some of the top clinics show that costs are around half the price in Spain. Fertility treatments are sometimes offered for free through the public health service in Spain, however, there are long wait lists.  

READ ALSO: What are the rules on IVF in Spain?

Amount spent on healthcare

The US spends more than any other country in the world on healthcare. In 2021, the US spent 17.8 percent of gross domestic product (GDP) on healthcare, nearly twice as much as the average OECD country. Spain spends just around 10 percent of its annual GDP on healthcare, or approximately €2,000 per resident annually.

Spain's healthcare system ranks fifth best in the world according to a recent study. Photo: Piron Guillaume / Unsplash

This means that the US is often at the forefront of medical advances and as a patient, you may be able to benefit from the latest in medicine and technology. For example, the US is one of the top five countries for cancer treatment in the world, according to BritMed health consultant. They state that "the US has some of the best cancer treatments and very high survival rates for colorectal cancer and the highest for breast cancer (over 88 percent). Many of the world’s leading cancer experts can be found in the US".

This isn’t always the case though and it doesn’t always follow that the more you spend on healthcare the better the system is. The US may have the best care for those who can afford it, but overall Spain may be better. According to the latest ranking by Radar Healthcare, Spain places fifth in a list of 33 countries with the best medical care and the US doesn’t even make the top 15.

Optional healthcare in the US

In the US health insurance is optional, meaning that if you lose your job and your company health plan, you won't be insured, unless you purchase your own, very costly, coverage.

While you will be treated in emergencies, you will have to pay the cost of medical care out of your own pocket. For people in the US who have no health coverage and are not very wealthy, paying this amount out of pocket often means going into debt.

Statistics show that nearly a quarter of Americans have medical debt - which means they are not able to pay their health bills.

This situation would not happen in Spain. Although purchasing private healthcare in Spain is also optional, it’s most likely that you would be covered by the public system.

Access to health services

There is a wide gap between the two countries. According to a Harvard University publication, “the current US healthcare system has a cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost. This contributes to avoidable healthcare disparities". 

In Spain, this is not the case, however much or however little money you have you will be able to be seen by a doctor and in the public system you’ll be treated exactly the same as everyone else with exactly the same access to treatments at zero extra cost.

The Commonwealth Fund pointed out that the US health system "can seem designed to discourage people from using services… Affordability remains the top reason why some Americans do not sign up for health coverage, while high out-of-pocket costs lead nearly half of working-age adults to skip or delay getting needed care.”

According to a tweet from Belén Montalvo, a Spaniard living in the US, in the US: “You are a client, not a patient".

La gente odia ir al médico no tanto pq sea caro -que para eso pagas el seguro y se supone que estás cubierto-, sino porque las aseguradoras hacen TODO LO POSIBLE para no pagar lo que les corresponde y muchas veces son meses de llamadas para q no te pongan en una lista de morosos.

— Aló Miami (ahora, en Tennessee) (@alo_miami) January 14, 2023

Waiting times

In the US, people are waiting longer to see a doctor than they used to, a survey from AMN Healthcare and its physician-recruiting division, Merritt Hawkins found.

The average time to wait for a doctor's visit has increased by eight percent since the survey was last conducted in 2017. In 2022, the average appointment wait time across 15 cities was 26 days. 

According to a survey by the Organisation for Economic Cooperation and Development  (OECD) “The share of people reporting that they sometimes, rarely or never get an answer from their regular doctor’s office on the same day is high in the United States (28 percent)”.

READ ALSO: Why people in Spain are facing longer waits to see a doctor

The latest data available shows that the average wait time to see a GP in Spain is 8.8 days. Two out of every three people in Spain wait more than a day to be seen by their local GP and in Primary Care, it’s more than a week, according to data from the latest Health Barometer updated by the Ministry of Health. Keep in mind though this doesn’t include specialists. To see a specialist, waiting times are much longer.

In Andalusia for example, to see a specialist such as a dermatologist you will be waiting three months, while in the US the average wait time for the same specialist was 34.5 days. It’s a similar story in Catalonia where you will be waiting five months on average for a colonoscopy or to see a urologist and two months for an MRI.

When it comes to non-urgent surgeries, the mean waiting time in the US was 62.3 days, with 95 percent of patients waiting 189 days or less according to BioMed Central Health Services Research.

The latest figures released by Spain's Ministry of Health reveal that almost 800,000 people are waiting for non-urgent surgical procedures and that they are having to wait longer than before. A historical high of 793,521 patients were, as of December 31st, 2022, waiting for surgeries across the Spanish healthcare system. The average waiting time in Spain is now 122 days.