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 the population of Spain was 48,085,361 on January 1, 2023. Of this figure, 39,881,155 were born in Spain, while 8,204,206 were born abroad. According to their nationality, 41,995,741 were Spanish and 6,089,620 were foreigners.

The Report on the Population of Immigrant Origin in Spain 2023 examines the 20 most numerous resident population groups according to country of birth, country of nationality and foreigners with residence permits. Among the most numerous population groups by country of birth are people from Morocco, Colombia, Romania, Venezuela, Ecuador, Argentina, Peru, United Kingdom, France, Cuba, Ukraine, Dominican Republic, China, Bolivia, Honduras, Germany, Brazil, Italy, Paraguay and Russia.

Infographic: Where do emigrants to Spain come from? | Statista

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With their higher birth rates and lower average age, the expansion of the immigrant population temporarily offsets the demographic imbalances of the pension system. On the other hand, however, the sociological and economic characteristics of this group place particular demands on the social protection system.

Immigrants' access to education, healthcare 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.

Infographic: How many doctors are there per capita? | Statista

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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?

Full health care for foreigners in Spain in public health centers includes all persons, regardless of their circumstances. However, to mitigate possible abuses in this regard, different protocols have been established.

One of these requirements is to prove residence in Spain for a minimum of 90 days.

In this way, foreigners with legitimate medical coverage in their countries of origin who seek to take fraudulent advantage of this service are denied access to public health care.

Despite the application of this stipulation, undocumented immigrants are granted access to health care, subject to a report from the social services attesting to the insufficiency of their minimum resources.

This demographic group, when it comes to the purchase of prescription drugs, is obliged to pay a percentage equivalent (40 percent) of the total cost, to that of a person of Spanish nationality with an income of less than 18,000 euros.

On the other hand, organ transplant operations to immigrants in Spain, is also regulated by health regulations, with the intention of avoiding health tourism.

Consequently, you must have a legal residence in Spain for more than 2 years to be able to register in a specific list of medical interventions.

However, regardless of the above, the Spanish public health system is recognized exclusively at the national level.

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.


Many will praise the Spanish healthcare system on World Health Day, which is celebrated on April 7, but the authors of this study will disagree.

This research, carried out in Madrid, Catalonia and Castile-La Mancha, points to a healthcare system dismantled by cutbacks, collapsed primary care and opaque administrations as the conditions causing this violation of the right. And the elderly, the chronically ill and immigrants as the main neglected.

Of course, as is often the case, those who have suffered most from this setback in our healthcare capacity have been the least favored and, among them, immigrants in an irregular situation.

In an administration that has erected significant barriers to access to healthcare, especially for those most dependent on the system, people without regularized immigration procedures have suffered doubly. On the one hand, due to the usual lack of resources that prevents them from turning to the private sector. On the other hand, because of the difficulty of benefiting from an already deteriorated public health system.

Thus, in addition to their usual lack of security, there are aspects such as the loss of employment for those who are in the process of extending their residency, difficulties in renewing their papers, cohabitation with many other people, greater difficulty in accessing telematic health formats due to a lack of technological resources, and a long etcetera.

Along with irregular immigrants, other sociological groups such as women, who represent 75% of caregivers in the domestic sphere and who have suffered the impact of the overload of care 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 illness and victims of gender violence, despite the fact that, between January and April 2020, calls to 016 increased by more than 1. 000 %, and online consultations soared by 67.3%.

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