Spain has the seventh best public healthcare system in the world according to the World Health Organisation (2021 rankings).

With primary healthcare services available within a 15-minute radius from where most people live and an average of 8 to 9 percent of annual GDP expenditure on healthcare, the public’s opinion of Spanish healthcare is generally very high, although long waiting times and a lack of healthcare personnel have slightly tarnished this reputation in recent years. 

If you’re thinking of moving to Spain or want to have an alternative to private healthcare,  you may be considering if you can have access to Spain’s public healthcare, and if so, what the process involves.

Who is eligible for public healthcare in Spain?

In order to qualify for healthcare in Spain, you have to be paying into the social security system or be eligible through one of a few other ways. Here’s a list of those who can access la sanidad pública.

• Pensioners resident in Spain, including those from a country that has a mutual agreement. This includes all countries in the European Economic Area (EEA). They must also have a permanent residence certificate.
• Employees and autónomos (self-employed) workers registered with social security and paying into the system.
• Residents who get certain social security benefits in Spain.
• Those who previously registered for social security payments, but whose entitlement has now expired.
• Those whose spouse pays into the social security system.
• Children and other dependents of those paying into the social security system.
• Those recently divorced or separated from a partner who is registered with social security and paying in. 

When you register for public healthcare in Spain you will receive a Tarjeta Sanitaria Individual or TSI card. As the name suggests, these are individual cards for each person. Children also get their own.

How do I apply for a public heath card?

Each of Spain’s autonomous communities has its own healthcare system and applying for your health card (often called TSI) varies slightly depending on where you live. Here’s what you need to know about applying for your card in some of the most popular regions for foreigners. 

Catalonia

In order to register for your TSI public health card in Catalonia, you usually need to go to your local CAP (Centre d’Atenció Primaria) primary healthcare centre and fill out an application form. You will also have to take several documents with you including your social security certificate, your green residency certificate, green residency certificate or TIE and your padrón certificate.

During the pandemic, Catalonia made it much easier to apply for your TSI card and now allows you to apply for it online. You will need digital copies of your green residency certificate, TIE or residence card, your padrón certificate and your social security certificate (given to you when you register with social security) to upload. If you don’t have these, you can authorise CATSALUT to look into your information and verify these documents online. You can apply for it here. 

Once this has all been processed, you will be assigned a doctor and can make an appointment from that moment onwards. Your TSI card will be sent to you in the post later and could take up to a month to arrive.

Valencia region

In the Valencian community your health card is known as a SIP card. All the information about the SIP cards can be found here. 

You can get one by going to your local health centre and applying there. You will need to take the necessary documentation such as your social security certificate, your green residency certificate or TIE and your padrón certificate.

Madrid

In Madrid, you can apply for your TSI card either in person or online, if you have a digital certificate.

You will need to show your residency card, TIE or DNI, your padrón certificate and a Document Accrediting you to the Right of Health Assistance called the DAD. This is issued by the Social Security office and shows whether you’re recorded as a worker, self-employed, pensioner or beneficiary. You can apply for the DAD certificate here. 

Those with a digital certificate can apply through this link which will allow you to attach the documentation you need.

Whichever way you apply, you will receive your physical card in the post to your home address.

The Madrid region has also recently introduced a virtual health card, which you can get after you have applied for the physical one. This will allow you to make appointments and access your test results , You can download it here. 

Once downloaded, you can go to your local health centre in order to activate it via a QR code and a pin number. You can also activate it from home by calling the phone number on the app. Someone will then give you the activation code.

Andalusia 

In Andalusia, you can only apply for your health card in person at your local healthcare centre. You can only renew it online or request a new one if you’ve lost it. You must take with you originals and photocopies of your green residency document or TIE, the social security DAD certificate that Madrid also requires, and your padrón certificate. 

You can find out more about the process here. 

Balearic Islands

In the Balearic Islands, the healthcare system is known as IB-SALUT. There are three ways to apply for your health card on the islands, these include by phone, in person at your local health clinic and online using your digital certificate or Cl@ve.

You will need your NIE or TIE and a recent colour photograph of yourself. IB-SALUT will then check your padrón and social security status for you and send you your card in the post. You can find all the information here. 

Canary Islands

In the Canary Islands you can only apply for your TSI card in person at your local health centre. Remember to take all the necessary identity documents with you such as NIE, TIE or residency certificate, social security documents and padrón and your health clinic will let you know if they need any other documentation.

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Most regions will have a similar or slightly different to the regions mentioned above. Make sure to get into contact with your local health centre to ask about what you need to bring along when you register.