ISPOR Europe starts this week in Barcelona, Spain. In honor of ISPOR, I will summarize some key attributes of the Spanish healthcare system based on a 2024 Report of the European Observatory of Health Systems and Policies and the Aragonese Institute of Health Sciences.
Country Summary
- Population: 48.4 million (as of 2023),
- Life expectancy: 83.2 years (as of 2022), the 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 consumption: 19.8% of individuals over 15 years of age were daily smokers.
- alcohol consumption: 6% of adults regularly drink excessively (below the EU average of 18.5%)
Health expenditure
- Health expenditure: 132 billion euros (as of 2021)
- Healthcare spending as a percentage of GDP: 10.8% (as of 2021)
- pharmaceutical expense: 12.7 billion euros
- Public spending on health care as a percentage of general health spending: 71.7% (as of 2021).
- out of pocket expenses: 20.6% of total health spending, largely allocated to pharmaceutical products and some prostheses
- Risk of catastrophic expenses for the patient: Very low; among the lowest in the EU due to various protection mechanisms (e.g. co-payment exemptions), accessible primary care centers and services provided free of charge at the point of use.
- Access to specialist. Family Physicians act as gatekeepers of specialized and hospital care
- Approach to health reform since 2018: Expand the population covered by the health system, reduce co-payments, improve the scope of covered services, strengthen primary care
Health insurance options
- Overview: The Spanish national health system (SNS) offers universal coverage to residents, largely financed by taxes. Health responsibilities, however, are transferred to the 17 Autonomous Communities (Autonomous Communities). The Ministry of Health is responsible for the general coordination of the health system under the governance of the Interterritorial Council of the SNS (Interterritorial Council of the National Health System, CISNS).
- Insurance Eligibility: Based on residence in Spain. (This marks a change from the 2012-2017 period, when eligibility was linked to people’s legal and employment status)
- Can patients unsubscribe from the public health system (SNS)?: No, however, people can purchase voluntary health insurance (VHI) if they wish.
- What proportion of patients buy supplemental health insurance?: 20.8% buy VHI (as of 2021)
Supplier Supply:
- hospital beds. 296/100,000 inhabitants, of which 81.4% of the beds are in public hospitals
- Nurse vs doctors: The ratio between nurses and doctors has remained below the average ratio for OECD countries (1.4 versus 1.97).
- Key concerns: Primary care physician shortages in rural areas, projected future shortages in some specialties (e.g., family medicine, anesthesiology, geriatrics, psychiatry, and radiology)
Recent political changes and challenges:
- Is euthanasia legal?: Yes, as regulated by Organic Law 3/2021
- Key challenges: Address access gaps (for example, limited dental and optical care coverage) and large waiting lists for some services.
For more information, you can read the full report.
