Spain’s conservative and far-right parties both aim to enforce changes to the country’s public healthcare system but in different ways, from a crackdown on medical tourism to limiting access to foreigners who haven’t contributed enough to the system.
Most pollsters in Spain say the November 29th general election will deliver a right-wing government.
The Local has already looked at what a possible Partido Popular (PP) and Vox coalition could mean for foreigners in Spain, as well as more specifically on how the two right-wing parties claim they’ll fix the country’s housing crisis.
As the election campaign carries on and housing takes centre stage, many foreigners in Spain may also wonder what a right-wing government would mean for them in terms of healthcare.
National priority or universal healthcare?
If the polls are to be believed and the centre-right PP fails to win an absolute majority and therefore relies on Vox to form a government, we can expect to see Vox’s headline ‘national priority’ policy move into the healthcare sector, at least on a rhetorical level.
Put simply, this would be like with other policy areas: Vox pushing the PP into more extreme positions, whether rhetorically or in policy terms.
Vox has stated its aim to repeal or drastically modify Spain’s universal healthcare framework, notability to abolish any legal route or statute that recognises the right to healthcare for foreigners without legal residence.
The far-right party argues that public resources and the efforts of the healthcare system should be directed exclusively towards Spanish nationals and legal residents who contribute to the tax system — a step which would represent a break with the universality of Spain’s health sector.
In a text from a vote in April, Vox claimed the national system is going through a “slow but steady decline” that would be causing the right to health protection “of Spaniards” to be “increasingly deteriorated”.
The party points to “massive immigration policies” as “one of the causes of this worsening” healthcare situation.
This has also been interpreted as another attempt to curb the so-called migration “pull factor” as Vox argues that providing free medical cover to undocumented migrants clogs up waiting lists and turns Spain into a magnet for illegal immigration networks, something many voices from within the PP would agree with.
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Preventing abuse of the system
Whereas Vox is more forthright in its rhetoric and tries to tie everything into its national priority, a future PP government will likely be less explicit and may focus more on measures to prevent abuse of the system — particularly from foreigners.
Put simply, this might mean steps to prevent unnecessary access to the system for some foreigners rather than the outright prioritisation of Spaniards.
This could include crackdowns on forms of medical tourism, such as preventing medical fraud by foreigners who travel to Spain to undergo medical treatment without there being efficient reimbursement mechanisms in place in their countries of origin.
In other words, an end to procedures for foreigners ultimately paid for by Spanish tax payers.
Limiting access for undocumented migrants
Both parties have said they want to limit healthcare access for undocumented migrants, though to varying degrees.
While Vox talks up its national priority policy and wants to openly deny all access to undocumented migrants, access to healthcare for foreigners in Madrid is quietly already under threat, with those in irregular legal situations particularly ostracised.
Data taken from the latest report by the Madrid Network for the Fight against Poverty and Social Exclusion (EAPN Madrid) and Médicos del Mundo show that nearly 2,000 people in an irregular administrative situation have faced problems accessing the Madrid healthcare system during 2026.
Among the main causes are the inability to provide proof of registration on the municipal register (the padrón) and the refusal of some local authorities to apply current national legislation.
According to regional government data, the DASE system (Healthcare Document for Foreigners), used by the Community of Madrid to manage healthcare for foreign nationals, continues to cause difficulties for minors.
Socialist MP Lorena Morales said recently: “There’s a lot of talk about defending life, but when those children are migrants, nobody cares. The national priority in Madrid doesn’t need Vox; Ayuso has been implementing it for a long time now, and it’s the most vulnerable people – children – who are being denied something as basic as access to healthcare.”
If the PP experiment in Madrid is anything to go by, we can expect a right-wing government to, at the very least, make access to healthcare harder for foreigners in irregular situations.
Increased privatisation
Both of Spain’s right-wing parties would also likely welcome greater privatisation in healthcare.
The PP-run Madrid region, headed by regional President Isabel Díaz Ayuso, has long used a semi-private model that critics say is moving further and further away from the concept of universal healthcare.
Bolstered public-private partnerships across the country would be in keeping not only with the Madrid model but also Vox’s willingness to privatise previously public sectors, notably its recently pledge to privatise Spanish pensions.
READ ALSO: Spain’s far-right Vox unveils plans to privatise public pension system
Regional agreements
For a look ahead, we can also examine the PP’s regional agreements with Vox where the hard-right party props it up.
In those autonomous communities where the PP relies on support from or coalitions with Vox, such as Extremadura or Aragón, the party has agreed to review public benefits and audit the costs arising from healthcare provision for foreign nationals, whilst distancing itself from proposals for total exclusion.
Where do the PP and Vox differ?
Tempting as it is for political pundits to view Spain’s right-wing parties as one bloc with the same policy platforms, as we have seen there are some differences between the PP and Vox.
In April 2026, the PP actually voted against a non-binding motion tabled by Vox in Congress which called for access to healthcare for migrants to be made conditional on the number of years they had paid social security contributions, as well as for those residing in Spain without proper documentation to be ‘repatriated’.
The centre-right party opposed the bulk of Vox’s non-legislative motion, although it does agree with its coalition partner in restricting the right to healthcare to “those who abide by the law, pay their taxes and have legal residence and established ties”.
The PP leader, Alberto Núñez Feijóo, had already made this clear in an interview earlier this year in which he spoke out against universal access because “irregular status cannot give rise to rights”.
During the debate in April, PP MP Antonio Román outlined what will likely be the conservatives’ stance on access to healthcare:
“The right to healthcare belongs to those who abide by the law, pay their taxes and have legal residence, and are firmly rooted here – that is to say, those who have a stable, genuine and verifiable connection to the country,” he said.
However, Román went on to draw a distinction with Vox’s stance: “This must be distinguished from healthcare, which must be provided in those circumstances where failing to do so is unacceptable to any decent society and to anyone with even the most basic humanistic principles,” added the MP.
In other words, unlike Vox, the PP hasn’t said that irregular migrants shouldn’t even receive care in emergency situations.
