Spain: Health System Expenditures - Health Systems Facts

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Total Health Spending, USD PPP Per Capita (2019): $3,616

(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 (2021), Health spending (indicator). doi: 10.1787/8643de7e-en (Accessed on 20 January 2021).
https://data.oecd.org/healthres/health-spending.htm

Current Health Expenditure Per Capita (USD) (2016): $2,390
Current Health Expenditure as Percentage of Gross Domestic Product (%) (2016): 9.0%
Domestic General Government Health Expenditure as Percentage of General Government Expenditure (%) (2016): 15.1%
Population with household expenditures on health greater than 10% of total household expenditure or income (2009-2015) (%): 5.7%
Population with household expenditures on health greater than 25% of total household expenditure or income (2009-2015) (%): 1.2%

Source: World health statistics 2019: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.
https://apps.who.int/iris/bitstream/handle/10665/324835/9789241565707-eng.pdf
https://www.who.int/gho/publications/world_health_statistics/2019/en/

Annual out-of-pocket payment, constant (2017) PPP per capita (USD) (2017): $817

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Oct. 6, 2020.
http://apps.who.int/nha/database/

Out-of-Pocket Spending as Share of Final Household Consumption (%) (2017): 3.7%

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

Remuneration of Doctors, Ratio to Average Wage (2017)
General Practitioners: 2.1
Specialists: 2.4

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

Remuneration of Hospital Nurses, Ratio to Average Wage (2017): 1.3
Remuneration of Hospital Nurses, USD PPP (2017): $56,300

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

“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.
https://ec.europa.eu/health/state/country_profiles_en
https://ec.europa.eu/health/sites/health/files/state/docs/2019_chp_es_english.pdf

“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.
https://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits
https://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/spain-hit-2018

“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.”

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Jan. 27, 2021 by Doug McVay, Editor.