Some people on the Costa del Sol had a perfectly normal week.

Their GP appointments ran. Their specialist referrals went through. Their test results came back on schedule. They heard about the doctors' strike the same way they hear about most local news: distantly, as something happening to other people.

The other group had 200,000 appointments cancelled in Málaga province alone.

Last week, 30,000 physicians across Spain's public health network walked out for five days. Emergency care, oncology, ICU, and dialysis continued to operate under servicios mínimos — minimum service requirements — set by the Andalusian government. Everything else was at risk. At Hospital Costa del Sol in Marbella, 70% of doctors and 80% of medical residents joined the walkout — among the highest rates in the region.

This issue is about what the strike revealed about those two groups.

The expats who came through last week without disruption all had one thing in common: private health insurance.

Those on Spain's public health system — the Sistema Nacional de Salud — National Health System — faced cancelled appointments and no rescheduling timeline. The backlog from five days of walkouts will take months to clear.

Those with private insurance — Sanitas, Adeslas, Asisa, or any other provider — found that consultations, tests, and procedures continued normally throughout. A different healthcare reality, running alongside the public one, is largely invisible until something like this forces the comparison.

That split was always there. The strike made it impossible to ignore.

This is not a single event. The Comité de Huelga — strike committee — has confirmed rolling weekly walkouts through June: March 16-20, April 27-30, May 18-22, and June 15-19. The action continues unless Spain's Ministry of Health agrees to negotiate directly with CESM, the national doctors' union leading the dispute.

After five days of strike action, the Ministry made no official contact. The union leader said the committee would suspend "if there's a negotiation horizon." There isn't one yet.

The next pressure point is this week: the PP party meets with the strike committee on Thursday, February 26, to discuss blocking the contested reform in Congress. ERC meets on Friday, February 27. Whether either meeting produces a deal that changes the March round is an open question.

Worth planning for March 16 as if it will happen.

Most expats on the public system never actually chose it. They registered at their centro de salud — health centre — when they arrived, received a tarjeta sanitaria — health card — and used it when needed. It was free, it was there, and for the occasional appointment, it was fine.

That's not a healthcare decision. That's the path of least resistance.

The public system in Andalucía was already running with four-month waits for specialist appointments before a single doctor walked out. The strike didn't create the pressure — it just made it visible in a way that's harder to ignore.

Private insurance costs depend on what you want covered. A basic Sanitas plan starts around €22 a month. A comprehensive no-copay option runs €57-80 a month (Confirmed February 2026). The main providers with English-speaking services and clinics across the Costa are Sanitas, Adeslas, Asisa, and DKV. For Marbella specifically, Clinica Excelan offers private GP services, including home visits in English, for those who want concierge-style access outside the big networks.

If you're on the public system and the strike hasn't affected you yet, it may be because you haven't needed an appointment during a strike week. March 16 is three weeks away.

If you have private insurance, nothing changes. Worth confirming your policy covers GP and specialist access (not just emergencies) before you need it.

If you're on the public system, your GP and specialist appointments are the most exposed. Anything non-urgent scheduled around March 16-20 is worth a call ahead. Emergency care is protected by law.

If you're weighing private cover for the first time, most providers issue a policy within a week. The período de carencia — waiting period — for general consultations is typically short; for surgery, it runs longer. Ask about waiting periods specifically before signing. A basic Sanitas plan starts around €22 a month. Full no-copay cover runs €57-80 (Confirmed February 2026).

Two phrases worth having for healthcare conversations this month:

¿Está abierta la consulta durante la huelga? — Is the clinic open during the strike?

¿Tienen médico de cabecera para pacientes privados? — Do you have a GP for private patients?

The doctors' strike didn't create two-tier healthcare on the Costa del Sol. It made the tiers visible. The public system has structural pressures that predate this dispute by years, and five more rounds of walkouts through June will surface them again, week by week. The useful question isn't whether to panic — it's whether the healthcare system you're relying on is the one you'd choose if you were deciding today.

Go deeper: The complete healthcare guide for Costa del Sol expats covers both systems, what each covers, how to register, and what to do when things go wrong.

Not bad for a Monday — A. and the WaypointSur team with cita previas pending