What Makes Spain’s Health System Stand Out
Spain delivers universal tax-funded public care through the Sistema Nacional de Salud (SNS). Access is tied to individual identification via the Tarjeta Sanitaria Individual health card, which works nationwide across all autonomous community services and pharmacies.
Spain restored full universal access in 2018 under , guaranteeing protection of health and public system care under equal conditions for everyone in the country, reversing prior restrictions from 2012.
Health performance is strong. Spain ranks among the highest for life expectancy in Europe and reports low levels of avoidable mortality and unmet health needs according to the 2024 Spain Health System Review from the European Observatory on Health Systems and Policies.
How Public Health Coverage Works in Spain
Spain’s SNS is organised regionally but interoperates nationally through the Tarjeta Sanitaria Individual. Presenting this card links you to primary care teams, prescriptions, and referrals anywhere in the SNS network.
Who Is Covered at Public Expense
Under the 2018 universality reform, people in Spain are entitled to public system care under conditions of equality, with specific administrative pathways to register eligibility.
Spanish Social Security guidance confirms that even foreign nationals not yet formally registered as residents have rights to protection of health and healthcare under defined circumstances.
Getting Your Health Card
Each autonomous community issues the Tarjeta Sanitaria Individual once entitlement is confirmed through Social Security, employment, pensioner status, or other recognised pathways.
If You Are Not Yet Entitled: The Convenio Especial Safety Net
People living in Spain who are not recognised as insured can buy into public coverage through a Convenio Especial special agreement. Current national guidance lists monthly contributions of €60 per person under 65 and €157 for those 65 and above, subject to proof of residence.
Health Coverage Rules Tied to Spanish Visa Categories
Most medium or long stay visas for non-EU citizens require proof of private or public health insurance equivalent to what residents receive in the Spanish public system and issued by an insurer authorised to operate in Spain. Travel-only policies are not accepted. For example, the Consulate of Spain in Los Angeles outlines health insurance rules for non-lucrative visas.
Is Healthcare Free in Spain for Foreigners?
Tourists: Care is not automatically free. Spain expects visitors from outside the EU to carry private travel or international medical insurance. The Government of Canada travel guidance strongly urges travellers to purchase comprehensive health insurance.
Residents: Once you hold a residence permit and are registered as insured, you access the SNS largely free at the point of use, except for prescription co-pays.
What Canadians Need to Know Before Moving
Canadian provincial health insurance is portable only in limited ways. The Public Health Agency of Canada and Settlement.Org note that provincial plans pay little outside Canada and may become invalid if you live abroad beyond a set period (usually 6-8 months).
British Columbia’s Medical Services Plan also warns that coverage is limited outside Canada.
Spain vs Canada: System Basics
| Topic | Spain | Canada |
|---|---|---|
| Funding | General taxation via SNS | Provincial/territorial plans funded by provinces with federal transfer |
| Eligibility | Legal residence + registration | Must meet residency requirements |
| Health card | Tarjeta Sanitaria Individual | Provincial health card |
| Out-of-pocket | Minimal, co-pay for prescriptions | No charges for basic care but gaps for drugs, dental, ambulance |
Nova Vista Holdings: Health and Life Transition Support in Spain
Nova Vista Holdings supports Canadian and other international clients relocating to Spain, combining property services with health and insurance navigation. We assist with:
- Pre-move consultations and insurance requirements
- Guidance on Social Security registration and health card acquisition
- Evaluation of whether a Convenio Especial is needed
- Coordination with authorized Spanish insurers
Contact us to create a personalized Health and Insurance Roadmap for Spain and to explore our integrated property and lifestyle services.
