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World Health Systems Facts

Spain: Health System Overview


Life expectancy at birth (years), 2021: 82.7
Maternal mortality ratio (per 100,000 live births), 2023: 3
Under-five mortality rate (per 1000 live births), 2023: 3.1
Neonatal mortality rate (per 1000 live births), 2023: 1.7
New HIV infections (per 1000 uninfected population), 2023: <0.1
Tuberculosis incidence (per 100,000 population), 2023: 5.9
Probability of dying from any of cardiovascular disease, cancer, diabetes, chronic respiratory disease between age 30 and exact age 70 (%), 2021: 9.3%
Suicide mortality rate (per 100,000 population), 2021: 8.7
Adolescent birth rate (per 1000 women aged 15-19 years), 2015-2024: 4.6
Adolescent birth rate (per 1000 women aged 10-14 years), 2015-2024: 0.1
Universal Health Coverage: Service coverage index, 2021: ≥80
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%
Diphtheria-tetanus-pertussis (DTP3) immunization coverage among 1-year-olds (%), 2023: 93%
Measles-containing-vaccine second-dose (MCV2) immunization coverage by the locally recommended age (%), 2023: 92%
Pneumococcal conjugate 3rd dose (PCV3) immunization coverage among 1-year olds (%), 2023: 92%
Human papillomavirus (HPV) immunization coverage estimates among 15 year-old girls (%), 2023: 75%
Density of medical doctors (per 10,000 population), 2015-2023: 42.94
Density of nursing and midwifery personnel (per 10,000 population), 2016-2023: 64.06
Density of dentists (per 10,000 population), 2016-2023: 6.03
Density of pharmacists (per 10,000 population), 2015-2023: 12.29
Domestic general government health expenditure (GGHE-D) as percentage of general government expenditure (GGE) (%), 2022: 15.22%
Prevalence of anaemia in women aged 15-49 years (%), 2023: 15.6%

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.


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
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%
Population coverage for a core set of services, 2021
– Total public coverage: 100%
– Primary private health coverage: 0%
Population aged 15 years and over rating their own health as bad or very bad, 2021: 7.7%
Population aged 15 years and over rating their own health as good or very good, by income quintile, 2021
– Highest quintile: 80.1%
– Lowest quintile: 65.2%
– Total: 71.1%
Life expectancy at birth, 2021: 83.2 years
Infant mortality, deaths per 1,000 live births, 2021: 2.5
Maternal mortality rate, deaths per 100,000 live births, 2020: 3.4
Congestive heart failure hospital admission in adults, age-sex standardized rate per 100,000 population, 2021: 167
Asthma and chronic obstructive pulmonary disease hospital admissions in adults, age-sex standardized rate per 100,000 population, 2021: 132
Hospital workforce per 1,000 population, 2021
– Physicians: 2.57
– Nurses and midwives: 4.01
– Healthcare assistants: 3.07
– Other health service providers: 1.2
– Other staff: 3.33
Practicing doctors per 1,000 population, 2021: 4.5
Medical graduates per 100,000 population, 2021: 14.2
Practicing nurses per 1,000 population, 2021: 6.3
Nursing graduates per 100,000 population, 2021: 23.0
Ratio of nurses to doctors, 2021: 1.4
Practicing pharmacists per 100,000 population, 2021: 126
Community pharmacies per 100,000 population, 2021: 47
Remuneration of doctors, ratio to average wage, 2021
– General Practitioners
– Salaried: 2.4
– Specialists
– Salaried: 2.7
Remuneration of hospital nurses, ratio to average wage, 2021: 1.4
Remuneration of hospital nurses, USD PPP, 2021: $54,000
Hospital beds per 1,000 population, 2021: 3.0
Average length of stay in hospital, 2021: 7.5 days
Average number of in-person doctor consultations per person, 2021: 4.8
CT scanners per million population, 2021: 21
CT exams per 1,000 population, 2021: 134
MRI units per million population, 2021: 20
MRI exams per 1,000 population, 2021: 110
PET scanners per million population, 2021: 2
PET exams per 1,000 population, 2021: 6
Proportion of primary care practices using electronic medical records, 2021: 99%
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%
Share of the population aged 65 and over, 2021: 19.8%
Share of the population aged 65 and over, 2050: 30.8%
Share of the population aged 80 and over, 2021: 6.1%
Share of the population aged 80 and over, 2050: 11.2%
Adults aged 65 and over rating their own health as good or very good, 2021: 44%
Adults aged 65 and over rating their own health as poor or very poor, by income, 2021
– Lowest quintile: 24%
– Highest quintile: 11%
– Total: 19%
Proportion of adults aged 65 and over reporting limitations in daily activities, 2021
– Some Limitations: 37%
– Severe Limitations: 12%
Share of adults aged 65 and over receiving long-term care, 2021: 12.4%
Estimated prevalence of dementia per 1,000 population, 2021: 16.9
Estimated prevalence of dementia per 1,000 population, 2040: 24.0
Total long-term care spending as a share of GDP, 2021: 1.0%
Long-term care workers per 100 people aged 65 and over, 2021: 4.9
Share of informal carers among the population aged 50 and over, 2019
– Daily carers: 8%
– Weekly carers: 4%
– Total: 12%
Share of long-term care workers who work part time or on fixed contracts, 2021
– Part-time: 22.8%
– Fixed-term contract: 30.5%
Average hourly wages of personal care workers, as a share of economy-wide average wage, 2018
– Residential (facility-based) care: 63%
– Home-based care: 60%
Long-term care beds in institutions and hospitals per 1,000 population aged 65 years and over, 2021
– Institutions: 43.4
– Hospitals: 2.0
Long-term care recipients aged 65 and over receiving care at home, 2021: 83%
Total long-term care spending by provider, 2021
– Nursing home: 52%
– Hospital: 17%
– Home care: 21%
– Households: 8%
– Social providers: 0%
– Other: 1%

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


Population, 2021: 47,487,000
Annual Population Growth Rate, 2020-2030: -0.1%
Life Expectancy at Birth, 2021: 83
Share of Urban Population, 2021: 81%
Annual Growth Rate of Urban Population, 2020-2030: 0.2%
Neonatal Mortality Rate, 2021: 2
Infant Mortality Rate, 2021: 3
Under-5 Mortality Rate, 2021: 3
Maternal Mortality Ratio, 2020: 3
Gross Domestic Product Per Capita (Current USD) (2010-2019): $29,565
Share of Household Income (2010-2019):
    Bottom 40%: 18%; Top 20%: 41%; Bottom 20%: 6%
Gini Coefficient (2010-2019): 33
Palma Index of Income Inequality (2010-2019): 1.3

Note: “Under-5 mortality rate – Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.
“Infant mortality rate – Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.
“Neonatal mortality rate – Probability of dying during the first 28 days of life, expressed per 1,000 live births.”
“Maternal mortality ratio – Number of deaths of women from pregnancy-related causes per 100,000 live births during the same time period (modelled estimates).”
Gini coefficient – Gini index measures the extent to which the distribution of income (or, in some cases, consumption expenditure) among individuals or households within an economy deviates from a perfectly equal distribution. A Gini index of 0 represents perfect equality, while an index of 100 implies perfect inequality.
Palma index of income inequality – Palma index is defined as the ratio of the richest 10% of the population’s share of gross national income divided by the poorest 40%’s share.

Source: United Nations Children’s Fund, The State of the World’s Children 2023: For every child, vaccination, UNICEF Innocenti – Global Office of Research and Foresight, Florence, April 2023.


Population, Midyear 2022: 47,558,630
Population Density (Number of Persons per Square Kilometer): 94.67
Life Expectancy at Birth, 2022: 83.91
Infant Mortality Rate, 2022 (per 1,000 live births): 2.18
Under-Five Mortality Rate, 2022 (per 1,000 live births): 2.64
Projected Population, Midyear 2030: 47,076,573
Percentage of Total Population Aged 65 and Older, Midyear 2022: 20.27%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2030: 24.67%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2050: 36.55%

Source: United Nations, Department of Economic and Social Affairs, Population Division (2023). Data Portal, custom data acquired via website. United Nations: New York. Accessed 12 May 2023.


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.


“The Spanish health system is characterized by three statutory subsystems that coexist: the universal national health system (Sistema Nacional de Salud, SNS); Mutual Funds catering for civil servants, the Armed Forces and the judiciary (MUFACE, MUGEJU and ISFAS); and the Mutualities focused on assistance for Accidents and Occupational Diseases, known as ‘Collaborating Mutualities with the Social Security’.

“The SNS is a national health system based in the principles of universality, free access, equity and fairness of financing, and is mainly funded by taxes. It is organized at two levels – national and regional – mirroring the administrative division of the country. Health competences are transferred to the 17 Autonomous Communities (ACs), with the national level being responsible, under the governance of the Interterritorial Council for the SNS, for certain strategic areas as well as for the overall coordination of the health system, and the national monitoring of health system performance.

“Main actors in the ACs are the Departments of Health, playing the role of a Health Authority (that is, regulation, planning, budgeting and third party payer) backed by specialized agencies, including a health technology assessment agency in some regions. Planning and regulation responsibilities lie essentially with the Ministry of Health when it comes to nationwide laws and plans, and with the Departments of Health of the 17 ACs when it comes to the local implementation of national regulation, or the development of regional regulation and policies.”

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.


“Population coverage by the SNS is almost universal (99.5%) and guarantees quite a comprehensive benefits package to all citizens. Entitlement is independent of employment status and personal wealth (García-Armesto et al., 2010). Civil servants are entitled to choose to have their health care purchased by entities other than the SNS [Sistema Nacional de la Salud], such as the Mutual Fund for State Civil Servants, and around 2 million people opt for this alternative. They continue to pay taxes like everyone else and the SNS pays private insurers a capitation fee to cover their health care costs. Those with this form of private coverage are expected to use private providers only and receive a special health card, different from the SNS health card.

“In 2010, new policies were put in place that reduced access to publicly financed health benefits: user charges were extended to more medicines, access to health care for adult migrants was reduced and the allocation of transfers from the central state to the regions was tightened, leading to spending cuts which have been more severe in some regions (for example, in Catalonia). The latter may have had an impact on the perception among the population of the quality of publicly financed health services and thus the desirability of VHI [Voluntary Health Insurance].”

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.


“Despite the impact of the economic crisis on Spanish society, the underlying principles and goals of the Spanish national health system have remained unchanged in practice. Reforms implemented since 2010, such as budget reductions and new regulations on the scope, breadth and depth of coverage, have not seemingly shown any substantial short-term impacts on health outcomes.

“The achievements of the national health system over the last decade include: the improvement of amenable and preventable outcomes; small inequities in access across socioeconomic groups for preventive services and medical examinations; the good level of financial protection that limits individuals’ financial hardship due to ill-health; productivity improvements within the health system; fairly good results in overall patient satisfaction with the health system; and solid progress in consolidating patients’ rights.

“However, several challenges remain, including trends in behavioural risk factors such as the rising obesity rates for both adults and children. There is also some uncertainty regarding the long-term impact of current socioeconomic conditions in the health and welfare of the Spanish population. Moreover, waiting times for surgery, diagnostic procedures and specialized visits remain high.

“The evolution of performance measures over the last decade show the resilience of the health system in the aftermath of the economic crisis, although some structural reforms may be required to improve chronic care management and the reallocation of resources to high-value interventions.”

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: Health System Overview - Coverage, mortality, expenditures - National Policies - World Health Systems Facts

Spanish Health System Overview
Health System Rankings
Health System Outcomes
Coverage and Access
Costs for Consumers
Health System Expenditures
Health System Financing
Preventive Healthcare

Healthcare Workers
Health System Physical Resources and Utilization
Long-Term Services and Supports
Health Information and Communications Technologies
Healthcare Workforce Education and Training
Pharmaceuticals

Political System
Economic System
Population Demographics
People With Disabilities
Aging
Social Determinants and Health Equity
Health System History
Reforms and Challenges
Wasteful Spending


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

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

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