# Health care / how it works / dual nationality



## Alex2020 (Jan 26, 2020)

Hi all,

I have a few questions about health care in Spain. 

To start with, I should mention that I'm lucky enough to have dual nationality (I have both English & Spanish passports), so (I think!) if I move to Spain, so long as I'm paying tax too, I should be okay healthcare wise?

So, what I'm not sure of is how a few things work. 

I have an unruptured brain aneurysm, which doesn't currently need any treatment other than yearly scans to make sure it's not changed (health not really effected, other than have to keep blood pressure decent).

In the UK, my GP has referred me to a Neuro hospital and I have to go there every year (was 6 months, now once a year as seems stable) for an MRI scan just to check nothing has changed.

What I'm not sure of, is how I'd go about that is Spain? Also, could I choose which hospital I went to, for example? (in the UK you can choose your hospital for your first outpatient appointment). 

I ask because there's one in the area I'm looking at, that seems very, very well respected in neurosurgery & neuro-interventional radiology, but I'm not sure if I can get referred by a Spanish GP, to a hospital that I choose (in the area I'd be living in). 

Looking at Catalonia by the way, in case that effects anything.


----------



## Chopera (Apr 22, 2013)

I live in Madrid and have regular PET scans on my lungs for metastatic thyroid cancer. Here you are assigned a hospital based on catchment area, i.e. the location of the medical centre you have registered yourself in. It is possible to be registered in a medical centre that is not particularly near where you live if it happens to be in the catchment area of a hospital you like, it just means you have to travel further to see your GP.

The hospital I am assigned to has a good reputation for cancer treatment (among other things), but I have to go to a different hospital for the scans, because that's where they have the machine. In order to "get into the system" I just went to my GP and he referred me to that hospital.

In my experience the different regions of Spain have different systems, so the above might not apply to Catalonia.


----------



## Alex2020 (Jan 26, 2020)

Thanks so much for your reply 

So, just to check, did you ask the GP to refer you to the hospital you're assigned to? Wondering if/how much input it's possible to have, like if you can request a GP to refer you to the hospital of choice that's good for your condition, so long as you're in their catchment area?

Also, sorry for all the questions, but is there a way to find what the capture area of a hospital is? 

Thanks! Really, really appreciate people's replies 




Chopera said:


> I live in Madrid and have regular PET scans on my lungs for metastatic thyroid cancer. Here you are assigned a hospital based on catchment area, i.e. the location of the medical centre you have registered yourself in. It is possible to be registered in a medical centre that is not particularly near where you live if it happens to be in the catchment area of a hospital you like, it just means you have to travel further to see your GP.
> 
> The hospital I am assigned to has a good reputation for cancer treatment (among other things), but I have to go to a different hospital for the scans, because that's where they have the machine. In order to "get into the system" I just went to my GP and he referred me to that hospital.
> 
> In my experience the different regions of Spain have different systems, so the above might not apply to Catalonia.


----------



## Chopera (Apr 22, 2013)

Alex2020 said:


> Thanks so much for your reply
> 
> So, just to check, did you ask the GP to refer you to the hospital you're assigned to? Wondering if/how much input it's possible to have, like if you can request a GP to refer you to the hospital of choice that's good for your condition, so long as you're in their catchment area?
> 
> ...


Here it's one hospital per catchment area, i.e. each hospital has its own catchment area and they don't overlap. So AFAIK you can't ask a GP to assign you to a different hospital for the catchment area because there isn't one. I guess it might be different for unusual conditions though, and it might be different in Catalonia. I'm afraid I can't help with that.

I'm not sure how the catchment areas are assigned or where to look them up either I'm afraid. They probably base it on a number of factors to make sure patients are evenly spread between hospitals.


----------



## MataMata (Nov 30, 2008)

Alex2020 said:


> I'm lucky enough to have dual nationality (I have both English & Spanish passports), so (I think!) if I move to Spain, so long as I'm paying tax too, I should be okay healthcare wise?.


Whether British or Spanish there is no direct link between paying tax and entitlement to healthcare.

Also AFAIK Spain does not permit dual nationality so I think you need to check out that side of things first. 

Not sure how it works in detail but if your Spanish nationalty is technical - due simply to parentage for example - and you have never lived or worked in the country it's possible it may not qualify you for health care.

As a rough parallel I believe that British nationals who have entitlement to Irish passports through parentage, and have gone down that route to overcome post Brexit free movement restrictions, cannot benefit from Irish healthcare - and a potential transfer to Spain - unless they are registered for it for which they have to have actually lived there for a year.


----------



## xabiaxica (Jun 23, 2009)

MataMata said:


> Whether British or Spanish there is no direct link between paying tax and entitlement to healthcare.
> 
> Also AFAIK Spain does not permit dual nationality so I think you need to check out that side of things first.
> 
> ...


While it's true that Spain doesn't rescognise dual nationality with Britain, Britain does - so it's possible that the OP could be Spanish & have later taken British nationality without formally renouncing the Spanish one! 

Brits who have taken Spanish nationality but not formaally renounced to Britain, can still have a Britiah passport. Britain doesn't consider that you've renounced unless it is to Britain. The renouncing you do when you take Spanish nationality doesn't count as far as Britain is concerned. You couldn't make it up!

If he has a Spanish passport & DNI then he should always use that to enter & leave Spain. 

A Spanish national is entitled to access the healthcare system. That's it. No need to have worked, no need to have lived here previously. Paperwork needs to be done, but that's all.


----------



## Juan C (Sep 4, 2017)

I have dual uk and Irish nationality. No problem in spain with that combination. 

Spain in general do not permit dual Spanish and another nationality, However, there are a few exceptions so you either need to check that out toser of that includes you, or never carry your two passports at the same time 

As for which hospital. I am 80 so have a number of things which need attention ! I have been referred by my GP to a few different hospital depending on which the GP decides is appropriate 

PS. From mine, family and friends experience over my 30 years here, the quality of the treatment has varied from excellent to appalling/ dangerous. So good luck


----------



## xabiaxica (Jun 23, 2009)

Juan C said:


> *I have dual uk and Irish nationality. No problem in spain with that combination. *
> 
> Spain in general do not permit dual Spanish and another nationality, However, there are a few exceptions so you either need to check that out toser of that includes you, or never carry your two passports at the same time
> 
> ...


It's Spanish / British dual nationality that Spain doesn't recognise. Spain does recognise dual with some countries though.


----------



## Juan C (Sep 4, 2017)

xabiaxica said:


> It's Spanish / British dual nationality that Spain doesn't recognise.


I do not want to split hairs but I understand it is spanish and another which is not allowed, except as I said in certain circumstances which are not always simple to explain. I have friend who knows she must not show out that she has Spanish and Swiss passports 

That is why I suggested those affected would be better to check their particular situation

http://www.exteriores.gob.es/Portal...cionParaExtranjeros/Paginas/Nacionalidad.aspx


----------



## Overandout (Nov 10, 2012)

xabiaxica said:


> While it's true that Spain doesn't rescognise dual nationality with Britain, Britain does - so it's possible that the OP could be Spanish & have later taken British nationality without formally renouncing the Spanish one!
> 
> Brits who have taken Spanish nationality but not formaally renounced to Britain, can still have a Britiah passport. Britain doesn't consider that you've renounced unless it is to Britain. The renouncing you do when you take Spanish nationality doesn't count as far as Britain is concerned. You couldn't make it up!
> 
> ...


This is all correct. My wife also has both UK and Spanish passports and this is exactly the situation.


----------



## Joppa (Sep 7, 2009)

I am not au fait with Spanish nationality law but there is a distinction between being a dual national at birth and applying for another nationality later, such as naturalisation. Many countries allow the former but not the latter without first renouncing the existing citizenship. Also there is a distinction between having a particular nationality and applying for a passport. I would assume that in Spain if someone is a dual national because of parentage (e.g. with British father and Spanish mother), it is quite in order to apply and obtain Spanish passport provided you don't get British passport as well. UK won't care if you have any other nationality but Spain does and you must take care not to mix the two or let them know you are holding and using both. Is that the situation? Some countries like Japan allow those born with dual or multiple nationality to hold multiple citizenships until adulthood, when an election has to be made to keep Japanese and renounce all other nationalities or retain foreign citizenship and renounce Japanese nationality. In actual fact a lot of people in such situations, especially those born in US of Japanese parentage because of jus soli law in US (anyone born in US is a citizen regardless of parentage), just don't bother with renunciation and keep on holding multiple nationality and passports. There is no penalty attached so they just keep quiet about holding foreign passport when dealing with Japanese authorities.


----------



## Overandout (Nov 10, 2012)

Joppa said:


> Also there is a distinction between having a particular nationality and applying for a passport.


Honestly, your entire post gives an interesting perspective, but this one line really makes me curious. What distinction is made? and by whom?

My understanding was that when my wife obtained her Spanish passport, she became fully Spanish for all legal points of view. Is this not the case?


----------



## Alex2020 (Jan 26, 2020)

Thanks for the replies 

I was born in the UK, but also registered at the Spanish consulate here. I used to have a Spanish passport (needs renewing), and I think they said that means I have a DNI, too, but not 100%.

I'm also in the Spanish 'familia book' etc.

Sounds like it's quite a complex situation, so I think the first thing I'll do, is renew my Spanish passport & see if I have a DNI too (consulate in London said if I had a Spanish passport, I will have a DNI - but that I need to contact the consulate in Scotland... which is odd, as I was registered at the consulate in Manchester!).

Fingers crossed on that one.

Still hoping I'd be able to be referred to the hospital of choice if/when I moved there, but that's sounding less likely it seems, unless I know the capture areas which I'm not sure how I find out about in Catalonia (Valencia).

Thanks again, some really great replies and lots to think about 



xabiaxica said:


> While it's true that Spain doesn't rescognise dual nationality with Britain, Britain does - so it's possible that the OP could be Spanish & have later taken British nationality without formally renouncing the Spanish one!
> 
> Brits who have taken Spanish nationality but not formaally renounced to Britain, can still have a Britiah passport. Britain doesn't consider that you've renounced unless it is to Britain. The renouncing you do when you take Spanish nationality doesn't count as far as Britain is concerned. You couldn't make it up!
> 
> ...


----------



## Alex2020 (Jan 26, 2020)

My passport is due to parentage and I have never lived there, that's true. I believe (according to the consulate in London), that I should have a DNI though. I need to renew the passport (in Scotland, London said!), then I guess I'll find out when I call/email them.




MataMata said:


> Whether British or Spanish there is no direct link between paying tax and entitlement to healthcare.
> 
> Also AFAIK Spain does not permit dual nationality so I think you need to check out that side of things first.
> 
> ...


----------



## Alex2020 (Jan 26, 2020)

Thanks for the reply, very interesting! 

Re: quality of care and so much variation, that sounds a bit scary! Is there any trend (areas or rural vs more urban)?

Thanks 



Juan C said:


> I have dual uk and Irish nationality. No problem in spain with that combination.
> 
> Spain in general do not permit dual Spanish and another nationality, However, there are a few exceptions so you either need to check that out toser of that includes you, or never carry your two passports at the same time
> 
> ...


----------



## Alex2020 (Jan 26, 2020)

Wow, a lot to think about!

My story is that I was born in the UK to an English mother, Spanish father. My birth was registered at the Spanish Consulate but not until I was, hmmm 16 or so. I then was given a Spanish passport (and I was entered into the Spanish family book then, too). I still have family there etc.

Not sure what that entitles me to? I guess I'll first renew the Spanish passport and find out 



Joppa said:


> I am not au fait with Spanish nationality law but there is a distinction between being a dual national at birth and applying for another nationality later, such as naturalisation. Many countries allow the former but not the latter without first renouncing the existing citizenship. Also there is a distinction between having a particular nationality and applying for a passport. I would assume that in Spain if someone is a dual national because of parentage (e.g. with British father and Spanish mother), it is quite in order to apply and obtain Spanish passport provided you don't get British passport as well. UK won't care if you have any other nationality but Spain does and you must take care not to mix the two or let them know you are holding and using both. Is that the situation? Some countries like Japan allow those born with dual or multiple nationality to hold multiple citizenships until adulthood, when an election has to be made to keep Japanese and renounce all other nationalities or retain foreign citizenship and renounce Japanese nationality. In actual fact a lot of people in such situations, especially those born in US of Japanese parentage because of jus soli law in US (anyone born in US is a citizen regardless of parentage), just don't bother with renunciation and keep on holding multiple nationality and passports. There is no penalty attached so they just keep quiet about holding foreign passport when dealing with Japanese authorities.


----------



## Alex2020 (Jan 26, 2020)

Oh, and I have the Spanish family book in hand (which my sister recently used to get her Spanish passport for the first time, a few months ago. I had one when I was 16 or 17. I'm now 42).

Not sure if that helps 



Joppa said:


> I am not au fait with Spanish nationality law but there is a distinction between being a dual national at birth and applying for another nationality later, such as naturalisation. Many countries allow the former but not the latter without first renouncing the existing citizenship. Also there is a distinction between having a particular nationality and applying for a passport. I would assume that in Spain if someone is a dual national because of parentage (e.g. with British father and Spanish mother), it is quite in order to apply and obtain Spanish passport provided you don't get British passport as well. UK won't care if you have any other nationality but Spain does and you must take care not to mix the two or let them know you are holding and using both. Is that the situation? Some countries like Japan allow those born with dual or multiple nationality to hold multiple citizenships until adulthood, when an election has to be made to keep Japanese and renounce all other nationalities or retain foreign citizenship and renounce Japanese nationality. In actual fact a lot of people in such situations, especially those born in US of Japanese parentage because of jus soli law in US (anyone born in US is a citizen regardless of parentage), just don't bother with renunciation and keep on holding multiple nationality and passports. There is no penalty attached so they just keep quiet about holding foreign passport when dealing with Japanese authorities.


----------



## Joppa (Sep 7, 2009)

The issue concerning dual or multiple-nationals varies and, as I said, I am not familiar with Spanish nationality law, other than what I can glean from Wikipdia.
About applying for your passport in Scotland. Many countries divide UK into consular areas and the consulate that deals with your affairs is the one they designate by your UK address.


----------



## 95995 (May 16, 2010)

Alex2020 said:


> Oh, and I have the Spanish family book in hand (which my sister recently used to get her Spanish passport for the first time, a few months ago. I had one when I was 16 or 17. I'm now 42).
> 
> Not sure if that helps


AFAIK you will not have an issue, but in case of disasters, legal issues and the like Spain will not recognise your British nationality and will not give the British consulate access whilst you are located in Spain. As regards health care, I have no idea, but given you have not lived in Spain nor paid into the system you may not have automatic access.


----------



## Lynn R (Feb 21, 2014)

EverHopeful said:


> AFAIK you will not have an issue, but in case of disasters, legal issues and the like Spain will not recognise your British nationality and will not give the British consulate access whilst you are located in Spain. As regards health care, I have no idea, but given you have not lived in Spain nor paid into the system you may not have automatic access.


I recall that we have/had a forum member from Canada (AllHeart) who obtained Spanish nationality by reason of the fact that her father was Spanish, then moved here. She started to receive health treatment here in Spain (including cancer treatment) immediately despite never having paid Spanish social security.


----------



## 95995 (May 16, 2010)

EverHopeful said:


> AFAIK you will not have an issue, but in case of disasters, legal issues and the like Spain will not recognise your British nationality and will not give the British consulate access whilst you are located in Spain. As regards health care, I have no idea, but given you have not lived in Spain nor paid into the system you may not have automatic access.


All a Spanish citizen had to do is enter and do everything in Spain with (preferably) their currently valid national ID card, or alternatively their Spanish passport.

Edit:
In addition there are many countries that do recognise dual nationality, yet still apply the same rules re Consulate assistance etc.

All a Spanish citizen *has *to do


----------



## Alex2020 (Jan 26, 2020)

Okay cool - odd though, that the Manchester one was the one that sorted the passport the 1st time, this time it's Scotland, when I live in South Wales at the moment. 



Joppa said:


> The issue concerning dual or multiple-nationals varies and, as I said, I am not familiar with Spanish nationality law, other than what I can glean from Wikipdia.
> About applying for your passport in Scotland. Many countries divide UK into consular areas and the consulate that deals with your affairs is the one they designate by your UK address.


----------



## stevesainty (Jan 7, 2011)

Alex2020 said:


> Okay cool - odd though, that the Manchester one was the one that sorted the passport the 1st time, this time it's Scotland, when I live in South Wales at the moment.


There are only 2 Spanish Consulates in UK now, one in London and one in Edinburgh, the Manchester one closed several years ago.


----------



## 95995 (May 16, 2010)

stevesainty said:


> There are only 2 Spanish Consulates in UK now, one in London and one in Edinburgh, the Manchester one closed several years ago.


Consulates can change from time to time, usually to reduce costs, but for Alex2020 the responsible consulate would normally be the one that took over the responsibilities of the consulate where his birth was first registered.


----------



## Chopera (Apr 22, 2013)

Yes my kids had dual Spanish/British nationality from the moment they were born, since I'm British and their mother is Spanish. When I registered each of their births with the Spanish authorities, they knew I was British but at no point did they ask a screaming one week old baby to renounce its British nationality! They happily registered my children, and later gave them a Spanish DNI even though it was obvious they also had British nationality by birthright.


----------



## kalohi (May 6, 2012)

Chopera said:


> Yes my kids had dual Spanish/British nationality from the moment they were born, since I'm British and their mother is Spanish. When I registered each of their births with the Spanish authorities, they knew I was British but at no point did they ask a screaming one week old baby to renounce its British nationality! They happily registered my children, and later gave them a Spanish DNI even though it was obvious they also had British nationality by birthright.


My kids have dual Spanish/US nationality from the moment they were born since I'm American and their father is Spanish. But when I got my kids their first Spanish passports I was told in no uncertain terms that by Spanish law they are SPANISH and ONLY Spanish, and if they held US passports they had to renounce them immediately. I said thanks for the information, and never did anything. They've been using both passports ever since, being careful to only show their Spanish passports to EU authorities. 

BTW, they got their DNI's just like any Spaniard with no problems. They were born in Spain and their father is Spanish, so in the eyes of Spain they are 100% Spanish.


----------



## Chopera (Apr 22, 2013)

kalohi said:


> My kids have dual Spanish/US nationality from the moment they were born since I'm American and their father is Spanish. But when I got my kids their first Spanish passports I was told in no uncertain terms that by Spanish law they are SPANISH and ONLY Spanish, and if they held US passports they had to renounce them immediately. I said thanks for the information, and never did anything. They've been using both passports ever since, being careful to only show their Spanish passports to EU authorities.
> 
> BTW, they got their DNI's just like any Spaniard with no problems. They were born in Spain and their father is Spanish, so in the eyes of Spain they are 100% Spanish.


That's interesting as I haven't got my kids Spanish passports yet. I never understood this "renouncing passports" business, as it makes no difference to your nationality, especially if it is obtained by birthright. You can simply apply for another passport in the future, if and when you need one.


----------



## 95995 (May 16, 2010)

Chopera said:


> That's interesting as I haven't got my kids Spanish passports yet. I never understood this "renouncing passports" business, as it makes no difference to your nationality, especially if it is obtained by birthright. You can simply apply for another passport in the future, if and when you need one.


Actually, you can yourself formally renounce UK *citizenship *direct with the UK, it take ages to be processed. OTOH the process in Spain is not recognised by the UK to the extent that the UK usually just returns your passport to you and you do retain your UK citizenship.


----------



## Overandout (Nov 10, 2012)

Chopera said:


> That's interesting as I haven't got my kids Spanish passports yet. I never understood this "renouncing passports" business, as it makes no difference to your nationality, especially if it is obtained by birthright. You can simply apply for another passport in the future, if and when you need one.


Yes it is odd. My wife looked into becoming Spanish around 20 years ago, and she was told by the UK authorities that when she did so, Spain would demand that she hand over her UK passport when renouncing her British nationality. But that as the document is property of the crown, the Spanish would by law have to return it to the UK, and that as soon as they received it, they would send it straight back to her!!

Nowadays, they don't bother with that. When she finally did it last year, she just said "yes" when they asked if she renounced her British nationality, and that was it.

The most difficult thing about it for her is remembering which passport number she has entered into flight bookings because the airlines won't let her board if she presents the "wrong" passport at the boarding gate. At immigration they don't care though. At least not pre-brexit anyway.
I suppose that after this Friday she will present her UK passport when entering the UK and her Spanish one when entering Spain. That's what I'd do anyway.


----------



## baldilocks (Mar 7, 2010)

Usually what happens is if you are in Spain, you cannot claim any of the advantages that a British passport may offer so if you were in court you can't say "But I am a British citizen"


----------



## Joppa (Sep 7, 2009)

Yes, that's what normally happens. Within Spain you are a Spanish citizen and nothing else, with all the rights and responsibilities. Your British citizenship just doesn't exist as far as Spain is concerned.


----------



## 95995 (May 16, 2010)

Overandout said:


> Yes it is odd. My wife looked into becoming Spanish around 20 years ago, and she was told by the UK authorities that when she did so, Spain would demand that she hand over her UK passport when renouncing her British nationality. But that as the document is property of the crown, the Spanish would by law have to return it to the UK, and that as soon as they received it, they would send it straight back to her!!
> 
> Nowadays, they don't bother with that. When she finally did it last year, she just said "yes" when they asked if she renounced her British nationality, and that was it.
> 
> ...


That is indeed the way to go and actually advised for all dual citizens everywhere. For example, the Australian government actually states that dual citizens should always enter and leave Australia on their Australian passport and their other country of citizenship on that passport (though of course there is no issue with EU citizens entering and leaving EU countries on an EU passport).

I have been confused in the past, so at the airline check-in I showed them both (not remembering which I had used for multiple flights to get to Europe ), but at passport control the relevant passport of that country.

(Actually for me Brexit just complicates matters a little bit more, given I have British and French citizenship from birth and Australian citizenship by naturalisation. Oh well, onwards and upwards, as they say.)


----------



## Isobella (Oct 16, 2014)

Chopera said:


> Yes my kids had dual Spanish/British nationality from the moment they were born, since I'm British and their mother is Spanish. When I registered each of their births with the Spanish authorities, they knew I was British but at no point did they ask a screaming one week old baby to renounce its British nationality! They happily registered my children, and later gave them a Spanish DNI even though it was obvious they also had British nationality by birthright.


A birth can be registered without being a resident.


----------



## Alinaga (Sep 11, 2017)

Well, 
I do not understand why the thread about medical insurance was moved . I have to ask my question about medical insurance in Spain and the information on this issue may have been useful for many. Lynn, for example informed us about convenient and not expensive insurance in Malaga area. I would like to ask if anybody has some good examples of insurance in Alicante for age over 65. In couple of years we shall move definitely to Alicante from Norway, and with several health problem arisen due to harsh climate, we have to find a good medical care. If somebody who lives already in Alicante is willing to discuss the issue with my husband and me, we would be happy to meet during Easter period.
Thanks.


----------



## Isobella (Oct 16, 2014)

baldilocks said:


> Usually what happens is if you are in Spain, you cannot claim any of the advantages that a British passport may offer so if you were in court you can't say "But I am a British citizen"


Would this happen if there were to be a crisis and expats wanted bailing out. Eg the China situation. Unlikely I know but just curious.


----------



## Joppa (Sep 7, 2009)

Depends. If you are stuck in an African country during a coup and you need bailing out, either UK or Spain can come to your assistance. But if there is a crisis in Spain, as a dual national you won't normally be eligible for special help from UK, though if you are in a family group and all your children and your spouse are UK citizen only, UK government may extend help to you as well.


----------



## Juan C (Sep 4, 2017)

I have dual nationality. I understand that the country who’s passport I am travelling on would the one that would provide assistance in an emergency situation


----------



## 95995 (May 16, 2010)

Juan C said:


> I have dual nationality. I understand that the country who’s passport I am travelling on would the one that would provide assistance in an emergency situation


It depends. With a major crisis, sometimes they opt for the country or birth rather than the country of naturalisation. However, you can normally advise the consulate of a country whose citizenship you hold that you want their assistance. Generally, if they don't know you have dual or multiple nationality, they are likely to default to the country whose passport you are travelling on - if that is not what you wish you should notify the consulate or foreign affairs department of the country whose services you want to use as a citizen of that country (and being resident of that country or having that nationality by birth can tip the scale in your favour). Can just be a wee bit messy and of course in the event of say a plane crash, their best information is either the passport you are travelling on or the passport you used when booking the ticket, bearing in mind however that the airline is usually the first to reveal the nationality of passengers involved because they are supposed to know who actually boarded the flight.


----------

