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In 2018, Spain took a historic step toward truly universal healthcare with the Royal Decree-Law 7/2018. This law confirmed that all people living in Spain, regardless of nationality, employment, or administrative status, have the right to access the National Health System.
The law also specifically clarifies the rights of foreigners without legal residence. As stated in Article 3 ter of the 2018 law:
“Foreign persons not registered or authorised as residents of Spain have the right to protection of health and health care in the same conditions as people with Spanish nationality, as established in article 3.1.”
In other words, while everyone residing in Spain is entitled to healthcare, the law explicitly extends these rights to people in irregular situations, who had previously faced barriers to access.
Plain-Language Summary:
The 2018 law guarantees that everyone living in Spain can access the National Health System. This includes:
The section about foreigners without legal residence is just one part of the law, designed to make sure that even those who previously had no access can now receive healthcare. But the law’s main principle is universal: if you live in Spain, you are entitled to healthcare.
Despite the clarity and importance of this law, many autonomous communities did not implement it, and some offices of the INSS created administrative obstacles. People legally entitled to care were sometimes told they could not apply, and certain procedures were interpreted in ways that effectively blocked access. This was not because the law was unclear, but because Spain’s health system is highly decentralized, and enforcement relied on cooperation from regional authorities. In some cases, the actions of officials could be described as prevaricación (misuse of authority), frustrating the universal intent of the law.
Now, in 2024–2025, the Spanish government has introduced new proposals to strengthen and properly implement the principles of the 2018 law. These reforms aim to:
Except for Andalucia, other regions did not implement the new law. Furthermore, Andalucia then backtracked, but at CAB, we did not give up and had a meeting with lawyers information below:
