Spain has a public health system, providing free or low cost health care for those contributing to Spanish social security, plus their families and retirees (including those from other EU countries).

However, although big improvements have been made in the last few decades the public health service is hugely over-burdened and there are long waiting lists to see specialists and have non-urgent operations in most areas.

To become an insured, you have to have a Social Security number (that you get usually through your work). If you pay Spanish social security (Seguridad Social) contributions, you and your family are entitled to free or subsidized medical and dental treatment on the same terms as Spaniards. Over 90 per cent of the population are covered by the Instituto Nacional de la Salud (INSALUD), Spain's public health scheme, including retired EU residents (with a residence card) in receipt of a state pension. If you're an EU national of retirement age, who isn't in receipt of a pension, you may be entitled to public health benefits if you can show that you cannot afford private health insurance.

Anyone who has paid regular social security contributions in another EU country for two full years prior to coming to Spain (e.g. to look for a job) is entitled to public health cover for a limited period from the date of their last social security contribution made in their home country. Social security form E-106 must be obtained from the social security authorities in your home country and be presented to the local provincial office of the Instituto Nacional de la Seguridad Social (INSS) in Spain. Similarly, pensioners and those in receipt of invalidity benefits must obtain form E-121 from their home country's social security administration. You will be registered as a member of INSALUD and will be given a social security card (cartilla), a book of vouchers, a list of local medical practitioners and hospitals, and general information about services and charges.

European Card for Sickness Insurance In case of medical care need when abroad in Europe, it allows European members to get refund for their medical expenses, according to the legal arrangement in the visited country. It replaces the E111 form and other European forms (E110, E119, E128) used for short term visits in European countries. It is an individual card with your name, and each family member should have one (including children under 16). It is valid 1 year and free. The card is not given automatically: you will need to ask your social security centre a few weeks before the departure.

When you receive your social security card, you will usually be assigned a general doctor (médico de cabecera) in the area where you live. You may be able to switch to another doctor in the same area, depending on availability and a doctor's number of patients. No payment is made when visiting a public health service doctor and members are simply required to produce their social security card.

Hospitals
There are long waiting lists for beds in some public hospitals (particularly the best ones). Hospitals are listed in Yellow Pages under hospitales and indicated by the international hospital sign of a white `H' on a blue background. A list of local hospitals and health centres treating social security patients is available from your local social security office.

Except in the case of emergencies, you must present your social security card or, if you aren't covered by social security, you must provide evidence of your health insurance or the ability to pay. If your private insurance company doesn't have an arrangement with a Spanish hospital to pay bills direct, you will have to pay the bill yourself (credit cards are usually accepted) or seek assurance from your insurance company that they will pay the bill.

If you have a Certificado of Empadronamiento, you have the right to emergency care in any public hospital.