Health care in Spain – Healthcare Economist

ISPOR Europe kicks off this week in Barcelona, Spain. In honor of ISPOR, I will summarize some key attributes of the Spanish health care system based on a 2024 report from the European Observatory on Health Systems and Policies and the Instituto Aragones de Ciencias de la Salud.

Country overview

• Population: 48.4 million (as of 2023),
• Life expectancy: 83.2 years (as of 2022), highest in the EU
• Fertility rate: 1.2 (as of 2022), below replacement levels
• GDP/Capita (current USD): 29,675
• GDP/Capita (purchasing power parity, USD): 46,332
• Obesity rate: 16%
• Tobacco use: 19.8% of individuals >15 were daily smokers
• Alcohol use: 6% of adults regularly engage in heavy drinking (below EU average of 18.5%)

Healthcare spending

• Healthcare spending: €132 billion (as of 2021)
• Healthcare spending as a share of GDP: 10.8% (as of 2021)
• Pharmaceutical spending: €12.7 billion
• Public healthcare spending as a share of overall healthcare spending: 71.7% (as of 2021).
• Out of pocket costs: 20.6% of total health spending, largely required for pharmaceuticals and some prostheses
• Risk of patient catastrophic expenditures: Very low; among the lowest in the EU due to several protection mechanisms (e.g., exemptions from co-payments), accessible primary care settings, services provided for free at the point of use.
• Access to specialist. Family Doctor’s act as gatekeepers to specialized and hospital care
• Focus of health reform since 2018: Widen the population covered by the health system, reduce co-payments, improve scope of covered services, reinforce primary care

Health insurance options

• Overview: The Spanish national health system (SNS) provides universal coverage for residents largely funded by taxes. Health competences, however, are transferred to the 17 Autonomous Communities (Comunidades Autónomas). The Ministry of Health is responsible for the overall coordination of the health system under the governance of the Inter-territorial Council for the SNS (Consejo Interterritorial del Sistema Nacional de Salud, CISNS).
• Insurance eligibility: Based on residency in Spain. (This marks a change from 2012-2017 when eligibility was linked to the legal and employment status of individuals)
• Can patients opt out of the public health care system (SNS): No, however individuals can purchase voluntary health insurance (VHI) if they desire
• What share of patients purchase supplemental health insurance: 20.8% purchase VHI (as of 2021)

Provider supply:

• Hospital beds. 296/100,000 inhabitants, of which 81.4% of beds are at public hospitals
• Nurse vs. doctors: The ratio of nurses to doctors has lingered below the OECD countries’ average ratio (1.4 against 1.97).
• Key concerns: Shortages in primary care physicians in rural areas, projected future shortages in some specialties (e.g., family medicine, anaesthesiology, geriatrics, psychiatry and radiology)

Recent policy changes and challenges:

• Is euthanasia legal?: Yes, as regulated by Organic Law 3/2021
• Key challenges: Addressing access gaps, (e.g., limited coverage of dental and optical care), and large waiting lists for some services

To learn more, you can read the full report.