Spain: Health System Coverage and Access

Population with household expenditures on health > 10% of total household expenditure or income (%), 2015-2021: 7.87%
Population with household expenditures on health > 25% of total household expenditure or income (%), 2015-2021: 1.12%
Universal Health Coverage: Service coverage index, 2021: ≥80

Source: World health statistics 2025: monitoring health for the SDGs, Sustainable Development Goals. Tables of health statistics by country and area, WHO region and globally. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.

Population coverage for a core set of services, 2021
– Total public coverage: 100%
– Primary private health coverage: 0%
Population reporting unmet needs for medical care, by income level, 2021
– Lowest quintile: 1.0%
– Highest quintile: 0.7%
– Total: 1.1%
Main reason for reporting unmet needs for medical care, 2021
– Waiting list: 1.0%
– Too expensive: 0.1%
– Too far to travel: 0.0%
Population reporting unmet needs for dental care, by income level, 2021
– Lowest quintile: 9.9%
– Highest quintile: 0.5%
– Total: 4.1%

Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.

“The national health system – Sistema Nacional de Salud (SNS) – is based on universal coverage and is mainly funded from taxes. While national planning and regulation remain the responsibility of the Ministry of Health, health competences and primary jurisdiction over operational planning at the regional level, resource allocation, purchasing and provision are devolved to the 17 regional health authorities. These often rely on the support of specialised national agencies such as the Network of Agencies for the Evaluation of Health Technologies and Benefits.

“The SNS Interterritorial Council, which comprises the national minister and the 17 regional ministers of health, is responsible for high-level coordination of actions across the regional health systems. It also played a key governance role in Spain’s health systemresponse to the COVID-19 pandemic (Box 1). In 2020, a new national-level Secretary of State for Health was created to improve communication of national health strategies and to enhance co-operation and coordination both among territorial health administrations and with international organisations.”

Source: OECD/European Observatory on Health Systems and Policies (2021), Spain: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels

“The SNS provides a comprehensive package of benefits covering primary, outpatient and inpatient care, as well as all licensed prescription pharmaceuticals. A limited range of dental services are available for the general population – including information and education, treatment of acute dental processes, minor surgery and treatment for somelesions – and services for some patient groups such as pregnant women and children. Currently, for other dental care procedures, the population must pay for elective dental care, which is linked to a very low share of public funding (Figure 14). Notably, Spain’s Recovery and Resilience Plan, funded by the EU, aims to expand coverage in a number of areas, including dental care, health promotion and preventive care.”

“The common core package of health care services of the SNS [Spanish National Health System] includes all health care prevention, diagnosis, treatment and rehabilitation services, as well as emergency medical transportation. Hence, the core package includes a comprehensive package of primary health care benefits (for example, acute and chronic care, health promotion and prevention activities, physiotherapy, mother and child care, mental health care, palliative care, medical counselling, basic dental health services), and specialized health care benefits (for example, any diagnostic and therapeutic procedure to be provided as outpatient specialized care, inpatient acute or long-term care, day-care surgical or medical care, palliative care, acute or long-term mental health care, home care, organ transplants, emergency care). These core benefits are not subject to any patients’ cost-sharing.

“In turn, pharmaceutical prescriptions and orthoprosthetic devices under the supplementary common package are subject to users’ cost-sharing. RDL 16/2012 indicates that co-payments must be set on the final product price, and be fixed according to the annual household income and a maximum ceiling of monthly payment.

“Finally, the accessory services, also subject to the same cost-sharing scheme, have been vaguely described as all activities, services or techniques, without character of benefit, that are not considered essential and/or are used as aid-devices for chronic care improvement. This third package has not yet been regulated.

“In the case of the complementary package of services, ACs [Autonomous Communities] may incorporate into their own package of benefits any technique, technology or procedure not covered by the common core package of the SNS, if they provide the resources needed for their financing.”

Source: Bernal-Delgado E, García-Armesto S, Oliva J, Sánchez Martínez FI, Repullo JR, PeñaLongobardo LM, Ridao-López M, Hernández-Quevedo C. Spain: Health system review. Health Systems in Transition, 2018;20(2):1–179.

Spain: Access and Coverage - Healthcare - National Policies - World Health Systems Facts

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Page last updated June 23, 2025 by Doug McVay, Editor.