Practical guide for foreign researchers in Spain 2008

9. National Healthcare System

Introduction to the Spanish National Healthcare System

The National Healthcare System (SNS) is the coordinated network of Spanish National Healthcare Services and Autonomous Region Healthcare Services that includes all of the functions and medical care that, pursuant to the law, are the responsibility of the public administrations.

The most relevant characteristics include:

• Public financing, universal coverage and free healthcare services for end users.
• Rights and responsibilities defined for citizens and the public administrations.
• Political decentralization of healthcare in the Autonomous Regions.
• Providing comprehensive healthcare with high levels of quality duly evaluated and controlled.

For more information, see the Ministry of Health and Consumer Affairs website at www.msc.es.

9.1. Medical Care

The Spanish Constitution of 1978 defined a regional organization for the Nation that has enabled the Autonomous Regions to assume responsibility for planning, public health and medical care. Each Autonomous Region has a Healthcare Service, which is the administration and management structure for all centers, services and establishments of the region, provinces, town councils and any other regional administrations.

Having completed the healthcare transfer process, all Autonomous Regions are now responsible for managing medical care within their territories. In the case of the Autonomous Cities of Ceuta and Melilla, the Spanish Central Administration manages medical care through the National Healthcare Management Institute (INGESA).

The National Healthcare System (SNS), as a health services provider, is organized on two levels: Primary Care and Specialized Care.

The main healthcare entities at the Primary Care level are the Health Clinics, which are manned by multi-disciplinary teams made up of family doctors, pediatricians, nursing staff and administrative personnel. They may also include social workers, midwives and physical therapists.

Specialized Care is provided at Specialty Centers and Hospitals, either in-patient or out-patient. Hospitals provide 24-hour emergency care to patients who have not been admitted.

The National Healthcare System covers all medication given during hospital stays. In the case of patients who are not hospitalized, medicine prescribed with a National Healthcare System prescription have a general 40% co-payment. In the case of chronic treatments, the participation percentage is 10%, with a maximum limit of 2.69%.

The directories for the Primary Care Clinics and Hospitals are available on the Ministry of Health and Consumer Affairs website at: www.msc.es/ciudadanos/prestaciones/home.htm.

Citizens with the right to protection and medical care

Citizens with the right to health protection and medical care include:

• All Spaniards and foreign citizens in Spain under the terms set forth in the article of Organic Law 4/2000.
• Citizens of the European Union Member States, whose rights are established by European Community law and the applicable treaties and agreements undertaken by the Spanish Government.
• Citizens of non-European Union countries whose rights are recognized by law, treaty and agreement.

Access to the services is obtained through the Individual Health Card issued by each of the Healthcare Services. This document identifies each citizen as a user of the National Healthcare System.

9.2. Private Insurance

Individuals who wish to receive private care may take out a health insurance policy in their country of origin with coverage in Spain, or take out a policy with any private medical entity established in Spain. It is important to remember that many of these entities have pre-existing condition waiting periods that may vary between several months to 1 year before being able to receive some of their services, especially in the case of maternity and surgery. The following is a brief list of some of the major providers. For a more complete list, see the yellow pages website, under "seguros" ("insurance", "sociedades médicas" ("medical entities") or "seguros médicos" ("medical insurance").

• ADESLAS Tel.: 902 200 200, www.adeslas.es
• ASISA Tel.:902 010 010, www.asisa.es
• MAPFRE Caja Salud Tel.: 902 20 40 60 www.mapfre.com/salud/
• SANITAS Tel.: 902 100 210 www.sanitas.es

When taking out a policy for any of these services, it is a good idea to compare prices, since in some case, in addition to the monthly or annual premiums, you must pay an amount per visit. It is also important to verify the national and international coverage of these policies. Some entities allow the insured to see the doctors of their choice, reimbursing a part of the fees that the insured paid to the specialist.

9.3. Pharmacies

In Spain, drugs are dispensed at pharmacies only. Users are generally required to present a prescription issued by the doctor responsible for providing the medical care. The hours at the pharmacies are the same as the commercial opening hours. There are "on-duty" pharmacies on the weekends (your regular pharmacy will have a list on the door with the address of the on-duty pharmacy for that weekend). Finally, there are some pharmacies that are open 12 and even 24 hours a day. When you request a drug, in addition to the well-know brands, the pharmacies can offer you generic medicines, which are generally less expensive that the commercial brands and contain the same active ingredients. Homeopathic products are also distributed at pharmacies.

The website of the General Council of Pharmaceutical Associations of Spain (www.portalfarma.com) offers a great deal of information on the Spanish pharmaceutical system.

9.4. Useful Addresses

• Ministry of Health and Consumer Affairs
  Paseo del Prado, 18-20, 28071 Madrid, Tel. 91 596 10 00
  www.msc.es
• National Healthcare Management Institute, INGESA.
  Calle Alcalá, 56, 28071 Madrid, Tel. 91 338 00 06
  www.ingesa.es