“Health expenditure in Spain followed the international upward trend until 2009. Since then, the trend has reversed, both in terms of expenditure per capita and as a share of GDP (Table 3.1). Indeed, between 2009 and 2015, government expenditure on health decreased by 0.9 points of the GDP, equivalent to a reduction of 5.3% – €68 870 million in 2009 to €65 199 million in 2015 – although an increasing trend has been seen from 2015. Most of the 2015 public expenditure went to the statutory SNS run by ACs (92.4%), whereas MFs (for civil servants and, accident and occupational diseases) spent 5.6% of the public expenditure, services linked to municipalities paid out 1%, and remaining central government services expended 0.9% of the overall public expenditure (MSSSI, 2017g).

“Public expenditure represents 71.1% of total health expenditure; this percentage decreased from 1995 to 2005 (from 72.2% to 70.6%), increased between 2005 and 2010 (up to 74.4%) and dropped again until 2015 (71.1%). In turn, private expenditure on health (as a percentage of total health expenditure) followed a U-shaped progression over the period, with a strong change in trend in 2010. Since then, this share increased to 28.9% in 2015. Voluntary health insurance, as part of private expenditure on health, grew from 1995 to 2005 (12.1% to 18.9%), decreasing thereafter and reaching 14.9% in 2015. Out-of-pocket (OOP) spending as a percentage of total health expenditure decreased until 2010 (from 23.5% to 22.1%), increasing again thereafter (to 23.9% in 2015) (MSSSI, 2017g).

“In 2015, Spain invested 9.3% of its GDP in health (Fig. 3.1). This level is similar to other NHS countries such as the United Kingdom (9.9%) and Italy (9%), although far from the levels of Sweden (11%), and from countries with social security-based models such as France or Germany, with higher percentages of GDP devoted to health (11.1% and 11.2%, respectively) (Figs. 3.1 and 3.2). In turn, per capita expenditure in Spain, at US$ 3183 purchasing power parity in 2015, is just below the United Kingdom and Italy and above Greece and Portugal (Fig. 3.3) (WHO, 2017b).”

Source: Bernal-Delgado E, García-Armesto S, Oliva J, Sánchez Martínez FI, Repullo JR, Peña-Longobardo LM, Ridao-López M, Hernández-Quevedo C. Spain: Health system review. Health Systems in Transition, 2018;20(2):1–179. http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/spain-hit-2018