What Spanish public healthcare includes and what it leaves out

Key rules

• Basic care: Basic services, including transport for urgent needs, are free when you use them.
• Co-payment: Medicines from a pharmacy and non-urgent transport are supplementary services, so you pay a co-payment.
• Transport: Non-urgent transport needs a doctor's prescription showing you cannot use ordinary transport.
• Regions: Your region can add services to the common list, so coverage can differ by region.

The short version

Public healthcare covers most medical care you would expect, free when you use it. Some items, such as medicines and non-urgent transport, come with a co-payment. Some things are left out, such as most adult dental care. Your region can add extras.

The three tiers of services

The list of services every region must offer is called the cartera común. It has three parts.

• Basic services (cartera común básica). Diagnosis, treatment and rehabilitation in primary care and specialist care, emergencies, preventive care and public health. These are free when you use them, including transport for urgent needs.
• Supplementary services (cartera común suplementaria). Medicines you collect from a pharmacy, orthoprosthetic products, dietary products and non-urgent health transport. You pay a co-payment.
• Accessory services (cartera común de servicios accesorios). Non-essential support items, such as some orthotics and prostheses. You pay a co-payment or are reimbursed.

What your region can add

Each region may add techniques, technologies or procedures on top of the common list, paid from its own budget. So what is offered can differ depending on where you live. To see what your region adds, search your regional health department's website for its "cartera de servicios". The checklist below shows where to look.

What is left out or limited

• Treatments without proven safety or effectiveness.
• Purely cosmetic surgery, unless it is linked to illness, accident or malformation.
• Most adult dental care, and optical products except in limited cases.
• Psychoanalysis, hypnosis and similar therapies. Spa treatments and some alternative therapies are limited.
• Assisted reproduction, which has age and clinical criteria that vary by region. These were widened in 2024 to include single women and women in same-sex couples.
• Medicines that are not prescribed or not on the public pharmacy list. Medicines are paid for by the system only if they are on that list.

Care at home

If you cannot get to the health centre, for example because you are immobilised, elderly, chronically ill or terminally ill, family doctors and nurses can visit you at home (atención domiciliaria). The health centre team decides how often, based on your condition. You or your family can ask your family doctor or nurse. This covers healthcare only. Social care comes under dependency services. Palliative care at home and hospital-at-home units exist in many regions, but not everywhere.

Non-urgent patient transport

Non-urgent transport is covered only if your clinical condition stops you using ordinary transport. That means you cannot move, travelling would put your health at risk, or you need medical supervision on the way. It must be to or from care covered by the public system. It also applies to treatments such as dialysis, radiotherapy or rehabilitation.

A doctor must justify it. Your family doctor or hospital specialist prescribes it on a medical form stating the clinical reason and the type of vehicle. In most regions your regional health service or its transport coordination centre (central de coordinación) then authorises it, sometimes after an administrative check at the hospital or health centre. Then you or the health centre book it, normally in advance.

Regions set their own detail, and some set priority or co-payment rules. Ask your health centre what applies where you live.

Checklist

Check what your region covers

• Look up the common portfolio (cartera común) of the National Health System on the Ministry of Health's website to see the basic, supplementary and accessory services every region must offer.

• Find your region's health department (consejería de sanidad) website or regional health service portal and search for its "cartera de servicios".

• Look in the regional list for extra techniques, technologies or procedures your region adds on top of the common portfolio, which it pays for from its own funds.

• Ask your family doctor or health centre whether a treatment you need is covered, if you cannot find it in the regional list.

• Ask your treating doctor, in primary care or the hospital, to prescribe non-urgent patient transport if you cannot travel by normal means for medical reasons. The doctor states the clinical reason and the type of vehicle on a medical form.

• Ask the health centre or your regional health service's transport coordination centre (central de coordinación) whether the transport needs administrative validation before it is authorised.

• Book the transport in advance, yourself or through the health centre, once it is authorised.

Quick answers on specialists and hospital care

Can I choose my hospital or specialist in the public system?

Yes, in many regions you can choose your hospital or specialist within your own region, but how far that choice goes differs by region. Madrid is the broadest, with one single health area. You usually ask at your health centre, or on the regional health portal or app, when your GP refers you. Choosing a hospital in another region needs a specific agreement.

What is a volante and who gives it to me?

A volante is the referral document your GP or paediatrician issues so you can see a specialist, have a test or use a hospital service. In many places it is now electronic and goes straight into the hospital system, so you get nothing on paper. Some regions still give a paper one that you hand in at the hospital.

Do I pay for a hospital stay or surgery in the public system?

No, covered hospital stays, surgery, specialist consultations and tests are free when you use them, if you are entitled to public care. You usually pay only the copayment on medicines bought at a pharmacy, and for a few items such as some orthopaedic aids and dietary products. Some regions also charge for transport in certain cases.

Can I get a non-urgent ambulance on the public system?

Yes, if a doctor certifies that your health condition stops you using ordinary transport, for example because you cannot move or need medical supervision on the way. It also applies to regular treatments like dialysis, radiotherapy or rehabilitation. Your treating doctor prescribes it, stating the reason and the vehicle type. The regional health service then authorises it, and you or the health centre book it in advance.