“Public expenditure is the primary source of funding for health in Spain (69.8% of total health expenditure). Public funds come mostly from general taxes and the ACs manage most of the public health resources (92.2% of public health expenditure and 64% of total health expenditure).

“Within the statutory national health service, the provision of health care in the ACs [Autonomous Communities] is funded through general taxation, up to 94.5% of public resources. In turn, MFs [Mutualism For Civil Servants] catering for civil servants, the Armed Forces and the judiciary (MUFACE, MUGEJU and ISFAS) deal with 3.4% of the resources, financed from a mix of payroll contributions and taxation. On the other hand, payroll and employers’ contributions that cover work injuries and professional diseases mutuality schemes amount to 2.1% of health funds. Finally, outpatient drugs prescriptions and some supplementary services within the package of benefits are the only health services whose costs are shared by patients. In practice, co-payments currently affect outpatient pharmaceutical prescriptions and specific orthesis and orthopaedic prosthesis. When it comes to private funding, payments come from a combination of OOP [Out Of Pocket] payments (co-payments and direct payments) and private medical insurance. Fig. 3.6 provides graphic detail on the SNS financial flows as well as pooling agencies.”

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.

“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: 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 2014, public spending accounted for 70.9% of total spending on health, with OOP [Out Of Pocket] payments and VHI [Voluntary Health Insurance] accounting for 24 and 4.4%, respectively (WHO, 2016). The public share has remained stable since 2000. Between 1981 and 2002, health competences within the national health system (Sistema Nacional de la Salud, SNS) were progressively devolved to the country’s regions (known as autonomous communities).”

Source: Joan Costa-i-Font. “Spain.” In Voluntary health insurance in Europe: Country experience [Internet]. Sagan A, Thomson S, editors. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2016. Observatory Studies Series, No. 42.

“The vast majority of public health expenditure in Spain is funded through general taxation (see Section 3.2, Sources of revenue and financial flows).

“The Spanish tax system is highly decentralized. The current regional financial scheme was agreed in July 2009 by the Economic and Fiscal Policy Council (in Spanish, Consejo de Política Fiscal y Financiera), a public body composed of representatives of the central and regional governments that is responsible for the fiscal and financial coordination between ACs and the central government. The corresponding legislation (Organic Law 3/2009 and Law 22/2009) was passed in December 2009, although the system was not enforced until the 2011 Spain’s General Budget Law was approved. Leaving aside social security contributions (which are earmarked for pensions and other monetary benefits), tax revenues can be grouped into two main categories: taxes linked to production and imports (“indirect taxes”, such as Value Added Tax, VAT); and “direct taxes” (that is, taxes on income and wealth). More than half of tax revenues (52.2% in 2015) come from indirect taxes, VAT being the main source of funds within this category (28.7% of total resources). Taxes on income and wealth provide 45.2%, with capital taxes adding the remaining 2.6% (direct taxes amount to 47.8%) (Ministry of Finance, 2017b). The aforementioned figures only applied to the so-called “common regimen of ACs” (that is, all the regions but Navarre and the Basque Country²), where the responsibility on tax collection is shared by the regional authorities and the Spanish Fiscal Revenue Agency (Agencia Estatal de Administración Tributaria). ACs are also responsible for the collection of those taxes assigned to the regional level (inheritance taxes, wealth transfer taxes) and share tax collection for VAT, personal income tax and excise taxes.”

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.

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 Sept. 22, 2021 by Doug McVay, Editor.