Paediatrician, A&E, health card: how we sorted healthcare for three kids

The first infection arrived in week three, on a Sunday of course, and in our youngest of course. At that point we had neither health cards nor a paediatrician and no idea where you go at the weekend. It ended well — but ever since, healthcare has been at the top of every moving checklist we write.

Getting into the public system

The Andalusian health service is called the Servicio Andaluz de Salud, or SAS. Anyone working or self-employed here and paying contributions is covered, and family members are covered with them. Getting in has three steps:

1. Apply for a social security number and have your registration confirmed. Without it there is no card.
2. Go to your local centro de salud — the neighbourhood health centre. All five family members are registered there and assigned to a doctor. Bring passports, NIE, padrón and social security proof.
3. Collect the card. The tarjeta sanitaria arrives a few weeks later. Until then, the printout from your appointment does the job.

The nicest part for us was step two: every child gets an assigned paediatrician — not an appointment with whoever is free, but their doctor, at the centre two streets away, responsible until their fourteenth birthday. All three of ours are with the same doctor, which makes appointments dramatically easier.

Appointments, waiting times and the app

We book GP and paediatric appointments through the SAS app or portal. It works well: pick a slot, turn up, done. For acute cases the centres run a walk-in clinic, usually in the morning for children.

Where the system struggles is specialists. A dermatologist or orthopaedic appointment can take weeks or months. That — not any lack of quality — is exactly why we took out private top-up cover after the first year. We use it almost exclusively for specialists, and for the cases where we want to be certain we understood correctly.

Emergencies

• 112 is the general emergency number, multilingual, valid everywhere in Spain.
• 061 is the medical emergency number in Andalusia.
• Urgencias is A&E. Larger health centres have one, hospitals obviously do. Children are generally seen quickly.
• Farmacia de guardia is the duty pharmacy. Which one is open is posted on every pharmacy door and listed online.

The pharmacy is more than a pharmacy

This was the nicest surprise. The Spanish farmacia is the first stop for anything small: a rash, an insect bite, a sore throat, a tick, sunburn. You get advice, you get something to take home, and you don't need an appointment. Plenty of things that would send you to a doctor elsewhere get resolved at the counter. For a family with three children that is a noticeable difference in everyday life.

Costs: medical care in the public system is free for children. Adults pay a share of medication costs depending on income, and it is well below what we were used to.

Dentists: where it turns private

Dental care is only partly covered by the public system. Andalusia runs a prevention programme for children that covers check-ups and basic treatment; anything beyond that — and for adults almost everything — is private. Prices vary widely and are negotiable. We tried three practices before finding one that takes children seriously and gives written estimates.

Language in the consulting room

In the coastal towns many doctors speak English and some speak German. In the public system you can't rely on it. Two things help: write your symptoms down in Spanish beforehand (a translation app is fine), and take someone with you for important appointments. We made the mistake early on of nodding politely. That backfires when it comes to dosages.

Where we've landed after two years

The care is good, for children very good, and it costs us less than in Germany. The price is patience with specialists and a willingness to work with a different system — one where the pharmacy does a lot and the specialist does little. If we could pass on one thing: register with the health system in your first weeks, not when the first fever arrives.

Common questions

Is the European health card enough?

For a holiday yes, for living here no. Once you are registered and paying social security, you sign up to the Spanish system and get your own card.

Do you need private insurance?

It isn't necessary. Plenty of families take it anyway, because you see a specialist in days rather than weeks and are often treated in English or German.

How does the pharmacy work?

A lot of what needs a prescription elsewhere is available here after a chat at the counter. Pharmacies are the first port of call for small things — and much faster than an appointment.

Everything here is our own experience, not legal advice. Authorities change rules, prices and forms constantly — always check the official site of the relevant office before an appointment.