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National markets insights: Spain



Spain - Healthcare system & market


The political organization of the Spanish state is made up of the central state and 17 highly decentralized regions (termed Comunidades Autónomas, that is, autonomous communities, ACs) with their respective governments and parliaments. With a population of 46 661 950 (1 January 2009), Spain covers 505 955 km and has the third largest surface area in western Europe.

The top three causes of death in Spain since 1970 have been: cardiovascular diseases, cancer and respiratory diseases, albeit there has been a steady decrease in the actual mortality rates from these causes. Still, mortality rates for these causes are among the lowest in the WHO European Region. Maternal and child health indicators (neonatal, perinatal and maternal mortality rates) have experienced a dramatic improvement, current rates scoring below European averages.


The statutory SNS is universal coverage-wise (including irregular immigrants), funded from taxes and predominantly operates within the public sector. Provision is free of charge at the point of delivery with the exception of the pharmaceuticals prescribed to people aged under 65, which entail a 40% co-payment with some exceptions. Health competences were totally devolved to the regional level (ACs) as from the end of 2002; this devolution resulted in 17 regional health ministries with primary jurisdiction over the organization and delivery of health services within their territory. The ACs’ financing scheme promotes regional autonomy both in expenditure and in revenue raising (especially after the 2009 revision). The national Ministry of Health and Social Policy (MSPS) holds authority over certain strategic areas, such as pharmaceuticals’ legislation and as guarantor of the equitable functioning of health services across the country. The highest body for SNS coordination is the CISNS, comprising the 17 regional ministers of health, chaired by the national minister. Decisions in the CISNS must be adopted by consensus and, as they affect matters that have been transferred, they can only take the form of recommendations.

ACs administer 89.81% of the public health resources, central administration spends 3% and 1.25% corresponds to the municipalities. Health care is the foremost policy responsibility of ACs. On average it accounts for 30% of ACs’ total budget.
Currently, almost all public health care expenditure (excluding civil servants’ mutual funds) is funded through general taxation. Taxation provides 94.07% of public resources; payroll and employers’ contribution to the work injuries and professional diseases mutuality schemes amount to 2.53% of health funds; the mutual funds catering for civil servants account for 3.4% of the resources.

More recently, due to worldwide economic crisis, the investments and expenditures (personal, material) in public healthcare system have been cut. One of the consequences is the development of the private sector, funded by a private insurances system completely separated from the public tax-based system. The recent years, number of private offers for healthcare have emerged in Spain.


WHO Spain healthcare review

National Health System - Spanish government

Organisation of the Spanish healthcare system - government source

Sustainability and future of the Spanish healthcare system

eHealth in Spain

Use of EHR in Spanish hospitals

Private healthcare situation analysis 2013 


Spanish ECHAlliance Ecosystems

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Adria Garcia joined the group National markets insights: Spain.
Posted 05 December 2018
DECSIS joined the group National markets insights: Spain.
Posted 26 May 2017
Utre joined the group National markets insights: Spain.
Posted 20 July 2016

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