In recent years, Spain's population increased by some 6.5 million people, representing a 7% growth in the number of foreign immigrants.

The INE reported that, as of January 1, 2024, the resident population born abroad was 8,838,234, as well as the foreign population born in Spain resident in 503,548, which adds up to a population of immigrant origin resident in Spain of 9,341,782. Of these, 234,548 were foreigners born in Spain and resident in the country, which means that the population of immigrant origin resident in Spain was 9,341,782, 19.21% of the total population, which was 48,619,695. Almost one in five people resident in Spain had immigrant origins.

Throughout 2023, the number of foreign-born residents in Spain increased by 634,028 people. The autonomous communities that registered the greatest variations were the Community of Madrid (132,634), Catalonia (132,195) and the Community of Valencia (106,169), closely followed by Andalusia (59,516).

On the other hand, according to the Report on the population of immigrant origin in Spain 2024 by the Jesuit Service to Migrants (SJM) Spain, which is a network of organizations that works to defend the rights of migrants and their full access to citizenship, the 20 most numerous resident population groups according to country of birth, country of nationality and foreigners with residence permits are: Morocco, Colombia, Venezuela, Romania, Ecuador, Argentina, Peru, United Kingdom, Cuba, France, Ukraine, Honduras, Dominican Republic, China, Bolivia, Brazil, Germany, Italy, Paraguay and Russia.

With its higher birth rates and lower average age, the expansion of the immigrant population temporarily compensates for the demographic imbalances of the pension system. But, on the other hand, the sociological and economic characteristics of this group impose particular demands on the social protection system. Because immigrants' access to education, health care and essential services are critical factors for their successful social integration.

However, the unequal distribution of immigrants throughout Spain has also led to a congestion of health services, especially in primary care, due to the application of the regulations of the Autonomous Communities.

How much does public healthcare cost per person in Spain?

In 2022, public spending on healthcare in Spain increased by 7.1%, or €4,034,029,000 million, to €96,844,457,000 million, representing 15.28% of total public spending. This value indicates that public spending on healthcare decreased by 0.39 percentage points, from 7.69% of GDP in 2021 to 7.3% of GDP in 2022.

Spain maintained its tenth position in the ranking of nations according to the size of healthcare investments in 2022.

In terms of its share of GDP, the situation has improved and it currently maintains a favorable proportion compared to the other nations. Among the 192 countries that make up the ranking, it ranks 21st.

When considering the proportion of public spending on healthcare in relation to the state budget, Spain ranks 33rd.

In 2022, Spanish public spending on healthcare per capita amounted to €2,042 per resident. In 2021 it was €1,957; thereafter, public spending on healthcare increased by 4.34%, or €85 per person. Spain currently ranks 26th out of 192 countries in per capita public spending on healthcare.

Public spending on healthcare has evolved over time.

For example, in 2017, Spain allocated 15.28% of its overall public spending to healthcare, up from 15.11% in 2016, 13.61% the previous year and 14.59% ten years earlier. (See full statistic) This indicates a steady upward trend in the proportion of public funds devoted to healthcare in recent years.

How is the medical assistance provided to foreigners in Spain?

The quality of healthcare is a particularly significant parameter for those who emigrate to Spain and constitutes one of their main concerns.

The Organic Law on the Rights and Freedoms of Foreigners in Spain and their Social Integration regulates foreigners' access to healthcare in Spain. According to this legislation, "foreigners have the right to health care under the terms provided for in current legislation on health care".

The significant influx of foreigners to Spain in recent years has led to changes in the accessibility of public healthcare. The Royal Decree of 16/2012, which linked healthcare to contribution and thus transformed the right to healthcare into a privilege, was one of the most significant.

The regulations concerning healthcare for foreigners in Spain are contained in Organic Law 4/2000.

This legislation establishes that persons with the status of insured are entitled to health care in Spain. This includes registered job seekers, employees, pensioners and beneficiaries of Social Security benefits.

Foreigners who have obtained legal residence in Spain have the same right to free health care as Spanish citizens.

Any student of foreign nationality who is duly registered and stays in Spain for a period of more than 90 days also has access to public health care under similar conditions to Spaniards.

In addition, people in exceptional circumstances, such as emergencies, pregnancy or serious illnesses, can also receive assistance.

The Spanish public healthcare system, which is not limited to its own citizens but also to people of other nationalities, is known for its high quality. But one of its distinctive features is the provision of free medical services.

This level of free medical care is available to foreigners legally residing in Spain.

Consequently, persons with legal residence are exempt from making immediate payments for medical assistance, procedures and/or treatments.

How do foreigners obtain medical services in Spain?

Comprehensive healthcare for foreigners in Spain's public health centers is universal and involves everyone, regardless of their circumstances. However, to mitigate possible abuses, different protocols have been established.

One of these requirements is to prove that you have been residing in Spain for a minimum of 90 days.

In this way, access to public healthcare is denied to foreigners with legitimate medical coverage in their countries of origin who intend to fraudulently exploit this service.

Despite the application of this stipulation, access to healthcare is granted to undocumented immigrants, provided that social services issue a report demonstrating that they lack minimum resources.

With regard to the purchase of prescription medication, this demographic group is obliged to pay a percentage equivalent (40%) to the total cost, which is the equivalent of a person of Spanish nationality with an income of less than 18,000 euros.

On the other hand, organ transplant operations for immigrants are also regulated in Spain in order to avoid health tourism.

To register on a specific list for medical interventions, you must have been legally resident in Spain for more than two years.

However, Spain's public health system is only national in scope.

Health card in Spain

To acquire a health card in Spain as a foreigner, it is essential to follow the following procedure:

1. Registration: The process of registering in a Spanish municipality is the initial requirement. The empadronamiento certifies your residence in a specific municipality. In some communities a minimum time of empadronamiento is required.
2. Necessary documentation: Documents proving your legal status in Spain are required. In general, the documentation to be presented may include your passport, residence permit, among other relevant documents.
3. Submit an application at the health center: After preparing all the required documentation, you must go to the health center associated with your home. Once the health authorities complete the required paperwork and certification, they will issue you a health certificate.

Conclusion

Many will praise the Spanish health system on World Health Day, which will be celebrated on 7 April, but there are researchers, politicians and members of civil society who do not agree with this approach.

The conclusions of the latest report on healthcare in the autonomous communities, drawn up by the Federation of Associations for the Defence of Public Healthcare (FADSP), which uses various indicators, determine that Navarre and the Basque Country continue to be the autonomous communities with the best public healthcare systems, while the Community of Valencia and Andalusia are at the bottom of the list, well behind. Furthermore, they conclude that health services in the autonomous communities have worsened in recent years and the existing inequalities between the different territories, which are large, not only are not diminishing, but are tending to increase.

This deterioration of public health services by the autonomous regions affects the population in general, but above all immigrants and, in particular, those in an irregular situation.

In a healthcare system that has erected significant barriers to accessing healthcare, especially for those who depend most on the system, people without regularised immigration status have suffered twice over. On the one hand, due to the usual lack of resources that prevents them from going to the private sector. And, on the other hand, due to the difficulty of enjoying an already deteriorated public health system.

Thus, in addition to the usual insecurity, there are other aspects such as the loss of employment for those who were in the process of extending their residence, difficulties in renewing their papers, living with many more people, greater difficulty in accessing online health services due to lack of technological resources, and a long etcetera of problems.

Alongside irregular immigrants, other sociological groups such as women, who represent 75% of carers in the domestic sphere and who have suffered the impact of the care overload due to the saturation of primary care, the elderly, who have had more obstacles to adapt to the telephone model or the Internet appointment system, chronic patients, those suffering from mental illnesses and victims of gender violence, despite the fact that, between January and April 2020, calls to 016 increased by more than 1000% and online consultations shot up by 67.3%.