Why Expats in Spain Complain About Healthcare While Foreigners Come Here to Get Treated: The Paradox of One System
November 17, 2025, Spain
You've probably heard it more than once: "Spain's healthcare is terrible! Long waits, bureaucracy, doctors don't want to treat patients." Such complaints are common among compatriots who moved here permanently. Yet at the same time, clinics in Barcelona, Madrid, and Malaga are filled with foreigners from Germany, France, the UK, and even the US. They pay thousands of euros to see Spanish surgeons, oncologists, and reproductive specialists. A paradox? At first glance—yes. In reality—it’s two sides of the same coin. Let’s explore why both perspectives are valid and how to avoid falling into disappointment.
Why immigrants are dissatisfied: Inside view of the public system
Most Russian-speaking expats in Spain (especially in Andalusia, Catalonia, and Costa del Sol) use the public healthcare system—Sistema Nacional de Salud (SNS). It's free for residents with a TSI card (Tarjeta Sanitaria Individual), but operates under strict European protocols. Here’s why this causes frustration:
1. The system works differently than “back home”
In Russia, Ukraine, or Kazakhstan, a doctor might order numerous tests “just in case,” prescribe antibiotics at the first sign of a cold, and immediately refer you to a specialist.
In Spain, your family doctor (médico de cabecera) acts as a gatekeeper. You start there, then get a referral. Tests are only prescribed when medically necessary. This isn’t about unwillingness to treat—it’s evidence-based medicine: minimizing unnecessary procedures to save resources and avoid patient harm.
Fact: According to Euro Health Observatory (2024), Spain leads the EU in low rates of unnecessary hospitalizations.
2. Waiting times are a real issue
Average wait for a specialist: 94 days (Spanish Ministry of Health, June 2024).
Surgeries: 121 days; 20% wait over six months.
In popular regions (Andalusia, Valencia): up to 150 days.
Living here long-term means facing these delays regularly—especially if you have children, elderly parents, or chronic conditions.
3. Language and cultural barriers
Even if you speak Spanish, medical terminology, regional accents, and communication styles create obstacles. English is rare in public clinics (except in Madrid and Barcelona).
Tip: Download the DGT Salud or Mi DGT app to book appointments online and translate documents.
4. Expectations vs. reality
Many arrive with the myth: "Everything in Europe is perfect." But they face bureaucracy, doctor shortages (especially in primary care), and post-pandemic backlogs.
Ipsos 2024 survey: 70% of Spaniards and expats complain about waiting times, yet 80% are satisfied with treatment quality once they receive it.
Why foreigners pay thousands of euros: Accessing the elite tier
Spain ranks 4th globally in medical tourism (Medical Tourism Index 2024). The market grows by 18% annually and will reach €4.16 billion by 2030. Tourists visit private clinics like QuirĂłnsalud, HM Hospitales, and ClĂnica Universidad de Navarra, where:
1. Top-tier quality at affordable prices
Oncology: ClĂnica Navarra leads cancer research in Spain.
Cardiology: Gregorio Marañón is top-ranked for heart transplants.
Transplantation: Spain ranks #1 in the EU for organ donation.
IVF and cosmetic surgery: 40–60% cheaper than in Germany or the US.
2. No waiting, maximum comfort
Appointments within 1–2 days. Doctors speak English. Rooms resemble hotel suites. JCI-accredited (international quality standard).
3. Medical tourism as a business
63% of medical tourists come from Germany,
19% from France.
Popular treatments: dentistry, sports medicine, orthopedics.
The government actively promotes it: National Health Tourism Plan 2024.
Conclusion: It depends on your perspective
Expats: Public system → Free, but with delays and barriers
Tourists: Private clinics → Fast, comfortable, top-quality care
Both views are correct. Spanish healthcare is neither perfect nor failing—it’s a balanced system where:
The public system saves lives for millions (life expectancy: 83+ years, among the highest globally).
The private sector offers elite services for those who can afford them.
Practical tips for expats
Combine systems: Use public care for routine needs + private insurance (Sanitas, Adeslas) from €50–200/month.
For residency visas: Insurance without copay is mandatory.
Best locations:
Madrid/Barcelona: More English-speaking doctors.
Málaga/Alicante: Many Russian-speaking clinics (e.g., Hospiten).
Check appointments/waiting lists: Use the Salud Responde app or Junta de AndalucĂa website.
P.S. If you’re in Spain or planning to move—start with choosing insurance. It will save your nerves and money.
This article is based on data from WHO, Spanish Ministry of Health, Statista, and expat reviews from 2024–2025.
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