How Spain's regional health systems differ

Key rules

• Health card: Your regional health card is valid in every region, so you get primary, urgent and hospital care anywhere in Spain by showing it.
• Your region: You are covered by the health service of the region where you habitually live.
• Pharmacy co-payments: The co-payment percentages are national and do not change by region.
• Local details: Extra services, waiting times and booking tools depend on your region, so check its health service.

One national system, run region by region

Spain has a single national health system, but the 17 regions plan and manage the services. Your doctor, your health centre and your hospital belong to your region's service. The Ministry of Health sets basic national policy and the list of services every region must offer. A council of the Minister and the regional health councillors agrees common criteria, such as updates to that list and waiting-time rules.

What is the same everywhere

• The common list of services. Every region must provide it. It covers public health, primary care, specialist care, emergency care, pharmacy, orthopaedics, patient transport and more.
• Core entitlements. These are set nationally, so a region cannot remove them.
• Pharmacy co-payments. The percentages depend on income and status. They are national.
• Shared digital systems. The Ministry runs the systems that let medical records and e-prescriptions work across regions.
• Your card. Your regional health card works in every region, as the key rules say. Moving or travelling within Spain does not leave you uncovered.

What can differ by region

• Organisation. Regions split their territory into health areas or zones. Some hospitals are run by private concession, as in Valencia and Madrid.
• Extra services. A region may add services beyond the common list, such as some dental, fertility or vaccine programmes.
• Reimbursement. Some items, such as transport and orthopaedics, are reimbursed differently.
• Waiting times. Waiting lists and priority rules vary.
• Digital tools. Apps, online booking and access to your records differ.
• Choice. How freely you can pick your GP, specialist or hospital varies.
• Prevention. Vaccination calendars and the ages for screening programmes differ.
• Access. Staffing and rural access vary.

Details change often, so check your region's health service before you rely on any of these.

Who runs your care

You are covered by the service of the region where you habitually live. Your padrón (the municipal register) and your registration at the local health centre show where that is. Each service has its own name and website. Examples are SAS in Andalucía, CatSalut in Catalonia, SERMAS in Madrid, SERGAS in Galicia, Osakidetza in the Basque Country and SACYL in Castilla y León. In Ceuta and Melilla, a national body called INGESA runs health care.

How to join your regional service

First prove you are entitled to the national system, for example through Social Security or a regional route for people without other cover. Then apply for the tarjeta sanitaria at your regional service or local health centre. The documents list below shows what to bring. Some regions accept proof of residence other than the padrón, and the process differs by region, so ask your health centre what it requires.

People without legal residence can still get care under national or regional rules for those in an irregular situation. Ask your health centre or regional service how it works where you live.

The FAQ below answers common questions about names, extra services and co-payments.

Documents you need

• Your ID or NIE (foreigner's identity number), to apply for the tarjeta sanitaria (health card) at the regional health service or your local health centre.

• A padrón certificate from your town hall, showing you live in the region. Some regions accept other proof of residence instead.

• Proof that you are entitled to the national health system, for example through Social Security (INSS), or through the regional route if you have no other cover.

Frequently asked questions

Who runs public health care in Ceuta and Melilla?

Health care in Ceuta and Melilla is run by INGESA, the national health management institute, which sits under the Ministry of Health. These two autonomous cities have no regional health service of their own. Everything else in Spain is run by one of the 17 regional services.

What are the regional health services called?

Each region has its own named service, such as SAS in Andalusia, CatSalut in Catalonia, SERMAS in Madrid, SERGAS in Galicia and Osakidetza in the Basque Country. Valencia's is often just called Sanitat. Look for that name on your health card and on the booking website you will use.

Can my region offer services that another region does not?

Yes, regions can add services beyond the common national list, such as some dental, fertility or vaccine programmes. Vaccination calendars and screening ages also differ. Ask your regional health service what it adds before you assume a service is covered.

Do pharmacy co-payments change from region to region?

No, the pharmacy co-payment percentages are set nationally, based on income and status. Regions do differ on reimbursing some items, such as transport or orthopaedic products. Check with your regional service for those.

Do I need to be on the padrón to join a regional health service?

Usually yes, because you are covered by the region where you habitually live, shown by your padrón (municipal register) entry. Some regions accept other proof of residence. Ask your local health centre which proof it takes.