Spanish Health System Overview
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Health System Outcomes
Health System Coverage
Costs for Consumers
Health System Expenditures
Spanish COVID-19 Policy
Health System Financing
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Health System Physical Resources and Utilization
Long-Term Services & Supports
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Population Insurance Coverage For A Core Set Of Healthcare Services (%) (2019):
Public Coverage: 100%; Primary Private Health Coverage: 0.9%; Total: 100%
*“Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
“Spain’s national health system, the Sistema Nacional de Salud (SNS), is based on the principles of universality, free access, equity and fairness of financing, and is mainly funded from general taxation. The 17 regional departments of health have primary jurisdiction over strategic and operational planning at the regional level, resource allocation, purchasing and provision, often with support from specialised agencies such as the Network of Agencies for the Evaluation of Health Technologies and Benefits. National planning and regulation are the responsibility of the Ministry of Health, Consumption and Social Welfare. The highest body for coordination is the SNS Interterritorial Council, which comprises the national and the 17 regional ministers of health.
“The SNS coexists with two other statutory subsystems: the three mutual funds catering for civil servants, the armed forces and the judiciary; and the mutual funds for accidents and occupational diseases.
“Reforms in the Spanish health system over the past decade have been influenced by measures responding to the economic crisis under the EU stability programme. Introduced in the early 2010s, these reforms have changed the governance of the SNS (notably by centralising spending rules) and redefined co-payments by patients for medicines and some other ancillary benefits.
“Health coverage entitlement was restricted in 2012 and linked to individuals’ legal and working status, but a royal decree-law in July 2018 restored universality to the SNS. In the new regulation, irregular immigrants have recovered eligibility to the same full coverage as any other Spanish national.”
Source: OECD/European Observatory on Health Systems and Policies (2019), Spain: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
“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.
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Page last updated July 21, 2022 by Doug McVay, Editor.