Overview

The Spanish national health system (SNS) provides virtually universal coverage and a comprehensive benefits package. The SNS is mainly funded from taxes, and care is predominantly provided within the public sector and free of charge at the point of delivery. The SNS is highly decentralized, with health competences devolved to the regions. The Ministry of Health is responsible for the overall coordination of the health system under the governance of the Interterritorial Council for the SNS.

Current health expenditure per capita in Spain was US$ PPP 4368 in 2021, below the EU average. Health expenditure from public sources accounted for 71.7% of total health expenditure in 2021 while out-of-pocket spending accounted for 20.6% of total health spending. Cost-sharing is limited to pharmaceutical prescriptions and some prosthetic devices, both of which incur co-payments. Patients mainly pay directly out of pocket for dental services, which only have limited coverage under the benefits package, and for optical care, which is outside public coverage except for a few very limited conditions.

Recent reforms in Spain have been implemented through various laws and strategies addressing the scope, breadth and depth of SNS coverage, with special emphasis on the most vulnerable groups. There is, however, room for improvement in addressing unmet needs for dental and optical care, as well as for mental health care. Future challenges to ensure a sustainable and resilient SNS include improving some access gaps, reducing overuse of low-value care and increasing technical efficiency.