There are several layers. In Spain there's national and regional level. Every autonomous community (~US State) manages it's own healthcare. The National Healthc

There are several layers. In Spain there's national and regional level. Every autonomous community (~US State) manages it's own healthcare. The National Healthcare System is only a framework for the regional ones, and provides some central services, but not for the consumer. You can travel to any other EU country and use their healthcare with an european healthcare card, and its cost will be transparent for you. In some system the regular card qualifies as an european healthcare card, in some others it doesn't. So it's a little bit of mess but it's mostly transparent for citizens.