Doctors, insurance and emergencies in Madrid

Getting into the public system

The Servicio Madrileño de Salud runs the regional public system. Once you are registered with the Seguridad Social and empadronado, you register at the centro de salud covering your address and are issued a tarjeta sanitaria individual and assigned a médico de cabecera. That doctor is the gatekeeper: specialists, tests and hospital referrals all route through them.

• Take the padrón certificate, NIE, and your social security document to the centro de salud.
• You are assigned to the centre for your address; changing it is possible but is a separate request.
• EU arrivals can use the EHIC for the gap before registration.

Private care, and why nearly everyone has some

Private insurance in Spain is inexpensive by northern European standards and is a common employer benefit. It is used chiefly to skip waiting lists for specialists, scans and elective procedures, and because appointments can often be booked directly rather than through a referral. Serious emergencies and complex care still tend to end up in the large public hospitals, which are very good.

• Policies typically carry a waiting period of several months for non-urgent procedures.
• Pre-existing conditions are excluded as standard — read the underwriting, not the price.
• Dental care is largely private in Spain, and cheap relative to most of western Europe.

Pharmacies and everyday care

Farmacias are dense, marked by a green cross, and pharmacists dispense and advise on a good deal without a prescription. Public prescriptions are subsidised, with the patient paying a percentage that varies with income and status, and the prescription is attached to your tarjeta sanitaria electronically rather than issued on paper. Every district runs a farmacia de guardia rota so one is open overnight.

In an emergency

112 is the single emergency number and reaches ambulance, police and fire, generally with English-speaking operators. Hospital urgencias use colour-coded triage, so a genuinely urgent case is seen quickly and a minor one waits a long time. For something in between, centros de salud run an urgencias service and the SUMMA 112 network operates urgent-care points across the region.

If you have no entitlement yet

Not everyone arrives on a payroll. Non-EU residents on the non-lucrative, teleworker or student routes must already hold Spanish private insurance with no co-payments as a condition of the visa, and that policy carries them. A legal resident with no other cover can later buy into the public system through the convenio especial, at €60 a month under 65 and €157 from 65, but only after a full year of continuous residence and registration on the padrón, so it is not a first-year option.

• EU citizens who are not working register on an EHIC or an S1 from home, and need comprehensive cover for the EX-18.
• Ask your centro de salud what it accepts while a TIE is pending rather than assuming; counter practice varies.