Spain: Health System Expenditures - World Health Systems Facts

Current health expenditure (CHE) per capita in US$, 2022: $2,910.84

Source: Global Health Observatory. Current health expenditure (CHE) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Out-of-pocket expenditure (OOP) per capita in US$, 2022: $558.20

Source: Global Health Observatory. Out-of-pocket expenditure (OOP) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%), 2022: 19.18%

Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic private health expenditure (PVT-D) as percentage of current health expenditure (CHE) (%), 2022: 25.97%

Source: Global Health Observatory. Domestic private health expenditure (PVT-D) as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic private health expenditure (PVT-D) per capita in US$, 2022: $756.08

Source: Global Health Observatory. Domestic private health expenditure (PVT-D) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) as percentage of current health expenditure (CHE) (%), 2022: 74.03%

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) as percentage of gross domestic product (GDP) (%), 2022: 7.21%

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) as percentage of gross domestic product (GDP) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) per capita in US$, 2022: $2,154.76

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Annual household out-of-pocket payment in current USD per capita, 2020: $569

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed May 13, 2023.

Health expenditure per capita, USD PPP, 2022
– Government/compulsory: $3,113
– Voluntary/Out-of-pocket: $1,319
– Total: $4,432
Health expenditure as a share of GDP, 2022
– Government/compulsory: 7.3%
– Voluntary/out-of-pocket: 3.1%
Health expenditure by type of financing, 2021
– Government schemes: 68%
– Compulsory health insurance: 4%
– Voluntary health insurance: 7%
– Out-of-pocket: 21%
Out-of-pocket spending on health as share of final household consumption, 2021: 4.0%
Price levels in the healthcare sector, 2021 (OECD average = 100): 86
Expenditure on retail pharmaceuticals per capita, USD PPP, 2021
– Prescription medicines: $420
– Over-the-counter medicines: $117
– Total: $538
Expenditure on retail pharmaceuticals by type of financing, 2021:
– Government/compulsory schemes: 715%
– Voluntary health insurance schemes: 0%
– Out-of-pocket spending: 29%
– Other: 0%

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

Domestic general government health expenditure (GGHE-D) as percentage of general government expenditure (GGE), 2021: 15.2%

Source: World health statistics 2024: monitoring health for the SDGs, Sustainable Development Goals: Statistical Annex. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO. Last accessed June 6, 2024.

Total Health Spending, USD PPP Per Capita (2021): $4,087

(Note: “Health spending measures the final consumption of health care goods and services (i.e. current health expenditure) including personal health care (curative care, rehabilitative care, long-term care, ancillary services and medical goods) and collective services (prevention and public health services as well as health administration), but excluding spending on investments. Health care is financed through a mix of financing arrangements including government spending and compulsory health insurance (“Government/compulsory”) as well as voluntary health insurance and private funds such as households’ out-of-pocket payments, NGOs and private corporations (“Voluntary”). This indicator is presented as a total and by type of financing (“Government/compulsory”, “Voluntary”, “Out-of-pocket”) and is measured as a share of GDP, as a share of total health spending and in USD per capita (using economy-wide PPPs).”

Source: OECD (2023), Health spending (indicator). doi: 10.1787/8643de7e-en (Accessed on 26 October 2023).

“In 2017, health spending per capita (adjusted for differences in purchasing power) was EUR 2,371, 15 % below the EU average of EUR 2,884. Health spending accounted for 8.9 % of GDP, also below the EU average of 9.8 % (Figure 7).

“Public spending accounted for 71 % of all health spending in 2017, less than the EU average of 79 %. The share of public spending on health decreased after the 2009 economic crisis due to cost-cutting measures and greater co-payments for pharmaceuticals. It has started to rise again in recent years, although it remains below its pre-crisis level.”

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.

“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$ 3,183 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, PeñaLongobardo LM, Ridao-López M, Hernández-Quevedo C. Spain: Health system review. Health Systems in Transition, 2018;20(2):1–179.

“When public health expenditure is broken down, the highest single item is inpatient care, which in 2015 amounted to 54.5% of total health expenditure (in fact, this share has increased over the years, reaching the maximum level in 2015). Outpatient care represents the second highest item in expenditure, being 15.4% in 2015, and pharmaceuticals are in third place at 14.1%. With regard to who is funding each service, while inpatient care and public health are mainly funded by the government budgets (92.4% and 96.1%, respectively), funding for other services is mainly shared by government budgets and OOP funding; 42.6% of governmental funds versus 43.2% OOP [Out Of Pocket], in outpatient care; 76% versus 21.7% in long-term care; and, 56.3% versus 40.7% in pharmaceutical care. Other prosthetic devices are essentially funded with OOP payments (94.8%) (see Table 3.2).”

“According to the Public Health Care Spending Statistics, there has been a 12.2% reduction in public health care expenditure between 2009 and 2015 (approximately €3671 million in market prices), equivalent to 0.6 GDP points reduction since 2009 (MSSSI, 2015c; MSSSI, 2017h). Official data suggest that the reduction is attributable to a decrease in personnel, pharmaceuticals and investment expenditure. Personnel expenditures endured a €2433 million reduction (8.0%) between 2009 and 2015, reflecting the decrease in salaries and workforce. Outpatient pharmaceutical expenditure experienced a €2890 million (21.5%) reduction between 2009 and 2015, a reflection of the 4.3% decrease in the volume of prescriptions (almost 4.4 million claims less) and 19.2% decrease in the average price per claim (MSSSI, 2017i). Comparing pharmaceutical expenditure before and after 2012 (when the pharmaceutical benefits were modified by RDL 16/2012), there was a more than 18.7% decline (around €1944 million less in 2014 compared with 2011) that has now diminished (González López-Varcárcel & Barber, 2017). Finally, capital spending endured a 60% reduction, decreasing €1532 million in the same period.”

Spain: Health System Expenditures - out of pocket, government spending, compulsory spending - National Policies - World Health Systems Facts

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Page last updated March 5, 2025 by Doug McVay, Editor.