Spain’s Top Three Regional Healthcare Systems


One of the unique aspects of the system is the fragmentation linked to the country’s 17 autonomous regions

The Spanish healthcare system performance is ranked as 7th in the world by the World Health Organization (WHO), beating countries such as Japan, the Netherlands, United Kingdom, and the United States. Additionally, in the Healthcare Access and Quality Index (HAQ), published by The Lancet, a UK medical journal, Spain was ranked as 8th in the world for its standard of healthcare, with 90 out of 100 points in a measurement of mortality rates from causes that should not be fatal in the presence of effective medical care. Based on 2015 OECD statistics, Spanish health spending is within the range of nine percent of GDP, totalling approximately EUR 97.4 billion.

The Spanish National Health System (SNS), is funded by taxes and predominantly operates through its public network of providers. One of the unique aspects of the system is the fragmentation linked to the country’s 17 autonomous regions; each of which leverages its own jurisdiction over the organisation and delivery of health services within the territory. When compared by community, the three largest “healthcare markets” of Spain are Madrid, Catalonia, and Andalucia.

In 2015, health expenditure per capita in Spain was EUR 2,374, falling below the European average of EUR 2,797. In terms of total expenditure, Catalonia leads the three communities, along with private expenditure and expenditure per capita. However, Andalusia surpasses Madrid and Catalonia in public expenditure despite having the lowest private expenditure. In all three communities, out of pocket (OOP) spending accounts for a majority of the private expenditure against private insurance (INSUR) spending.


Spain enjoys universal healthcare with both public and private systems which provide free basic healthcare. Around 90 percent of Spaniards use the public healthcare system, with some 19 percent signed up to some sort of private healthcare scheme in order to combine the best of both systems. In total, 98.7 percent of the population is insured for Spanish healthcare. Meanwhile, the number of people in Spain with private health insurance has grown in the last five years to 500,000 people, a 5 percent increase, thanks to innovative and customised services.

In 2016, Catalonia had the highest number of people enrolled in private insurance schemes followed closely by Madrid. Madrid had the highest share of premiums paid by patients throughout Spain, nearly a quarter at 24.4 percent, as well as the highest volume of premiums paid, EUR 1,706 million. However, Andalusia held the highest growth of premiums paid between 2013 and 2016 at 5.7% CARG.


In 2016, there was a total of 764 hospitals in Spain, a slight decrease from 771 in 2016. Catalonia had more than double the number of private hospitals than public hospitals in the community, and also doubled the total number of hospitals of Andalusia, the second most densely populated community. However, Andalusia had the most pharmacies with 3,878 followed by Catalonia then Madrid.

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