Spain’s public health service (Sistema Nacional de Salud) is free at the point of use. While it often works well, sometimes better than private alternatives, the system is feeling the pressure of an ageing population and funding cuts, especially at GP level.

This, and Spain’s growing prosperity, is increasing the popularity of private health care.

Going private may provide more comprehensive cover, especially as public healthcare offers only a rudimentary dental service and, of course, no added extras like cosmetic surgery. The culture of obstetrics and pediatrics in the public system can prompt people to choose a private option, because while the service is attentive, the attitude can be one of ‘doctor-knows-best’ (though this is changing).
One key difference between private and public healthcare is language. Few doctors speak English, so you may prefer the English speaking services offered by Bupa, Sanitas or AXA PP (see private health insurance).

Serious emergencies default to the public health services, taking patients by ambulance to the nearest hospital with A&E (urgencias). Public hospitals deal with emergency cases regardless of the patient’s social-security status. Ambulance arrival times in Barcelona were poor a few years ago, and since 2004 the regional Catalan government (Generalitat de Catalunya) has committed extra funding to improve response times to within 10 minutes for the most urgent cases.

Health cover is not mandatory in Spain, but it’s well-advised to opt for some kind of policy if you don’t qualify for social security. If you can choose between public and private, though, it needn’t be all or nothing: many here ‘top up’ public health with basic medical plans that can be good value.