Spanish Public Healthcare (Sanidad pública)

Since the General Health Act of 1986, Spain has run a residence-based universal healthcare system — the Sistema Nacional de Salud (SNS). The biggest contrast with single-payer contributory systems is that it is funded through general taxation, not separate health-insurance premiums, and that the 17 autonomous regions (Comunidades Autónomas) operate health services directly, so even though the SNS is national, day-to-day delivery in Madrid, Catalonia, and Andalusia looks quite different. Once you complete empadronamiento and register with the regional health authority, you can access primary care (atención primaria) essentially free of charge.

Enrolment and the health card

• Workers, self-employed people, pensioners, and their dependants with a Seguridad Social number (NUSS, Número de la Seguridad Social) are automatically covered by the SNS.
• Non-EU foreigners with a residence permit are in practice covered at the regional level once they have completed empadronamiento (the trend has expanded since RD-Ley 7/2018).
• To get the individual health card (tarjeta sanitaria individual, TSI), apply at your local primary-care centre (centro de salud). Card names and designs differ by region — TSI CatSalut in Catalonia, TSI SERMAS in Madrid, Tarjeta Sanitaria de Andalucía in Andalusia, and so on.
• For short-term family visits from Korea, the European Health Insurance Card (EHIC) or the emergency-care provisions of the Korea–Spain bilateral arrangement may apply in limited circumstances; check with Korea's National Health Insurance Service before departure.

How care is organised

• Primary care (primaria) — you register with a family doctor (médico de familia) or paediatrician (pediatra). Unlike Korea, walk-in visits to a major hospital are difficult; the GP acts as gatekeeper.
• Specialist care (especializada) — requires a primary-care referral, and waits can be long depending on the region and specialty (some non-urgent surgery: 6 months or more).
• Emergency care (urgencias) — accessible regardless of insurance or residence status. As a rule, foreigners in genuine emergencies are not turned away.
• Medication — patient co-payments (aportación) on prescription drugs range from roughly 10% to 60% depending on residence status, income, and age.

Common pitfalls for newcomers

• Private insurance (seguro privado) — long public-system waits push many residents to take out supplementary policies with Sanitas, Adeslas, DKV, etc. Some study and work visas require private cover, so check requirements by visa type.
• Re-registering after a regional move — if you move from Madrid to Barcelona, you must re-register with the Catalan health authority and a new card will be issued. Different region, different card.
• Temporary NIE without empadronamiento — primary-care registration is sometimes refused if your residence registration is incomplete, so handle empadronamiento first.

Official guidance: Ministerio de Sanidad, Seguridad Social – Asistencia sanitaria. Regional information is available from the regional health authorities — SERMAS (Madrid), CatSalut (Catalonia), SAS (Andalusia), and others.