• Spending overview
• Policy overview
• Diseases overview

Spending overview

In the ten years to 1995, healthcare spending increased sharply as a percentage of GDP, and then stabilised at a relatively low level for an industrialised nation. In 2009, however, Spain's GDP fell dramatically and it will remain weak in 2010, pushing up the proportion of national income devoted to healthcare. Over the forecast period, spending will start to decline as a percentage of GDP as the economy recovers slowly.  The public healthcare system is funded almost entirely from general taxation. Healthcare is free at the point of use for most citizens, although the wealthy self-employed are excluded. According to the OECD, public expenditure accounted for 71.8% of total health spending in 2007, which compares with 79% in France and 76.9% in Germany.

Increased prosperity and sophistication, as well as rapid population growth, which has put pressure on the public system, have pushed consumers towards private health insurance, and allowed them to pay for specialist treatment when publicly funded facilities are underequipped or overbooked. Demand for private health services is expected to grow, partly reflecting the influx of pensioners from northern Europe in the past decade. As the population ages and more women enter the workforce, the market for homes for the elderly will grow. The public system currently pays for pensioners' medicine costs, irrespective of income. Spending on medicines has risen sharply since the early 1990s, and as in other EU countries, clamping down on prices has become a key government healthcare objective.

Policy overview

Although overall healthcare spending in Spain remains lower than the EU average, the Spanish healthcare system has consistently ranked highly in Europe and further afield. Spain has a greater proportion of doctors than the OECD average (this excess supply of doctors is one reason why the cost of running the health system has been relatively low until recent years). There have traditionally been long waiting lists for treatment in public hospitals. To help counteract this, the government has tried to establish an internal market within the health system, and there have been significant reforms in the past decade.

In 1999 the government approved legislation allowing public hospitals to become self-governing and in 2001 full healthcare power was devolved to the 17 autonomous regions. To ensure that the resulting 17 regional health structures did not lead to greater waste and inefficiency, the central government at the same time introduced elements of an internal market and gave some hospitals greater management autonomy. Some regional governments are seeking greater market-led provision within the public system via private foundations.

Spain also has a well-established private healthcare industry. This evolved at a time when public provision was neither universal nor particularly good. Despite the substantial improvement in public healthcare in the past two decades, private healthcare insurance has continued to thrive. Indeed, as demand for medical attention outstrips public-sector supply, the state itself is becoming an increasingly important client of private healthcare companies.

Diseases overview

The general standard of health among Spaniards will remain high over the forecast period. Life expectancy, which is already among the highest in the world, at an estimated 80 years in 2009, is expected to continue rising, while the infant mortality rate, at an estimated 4.2 per 1,000 live births in 2009, is one of the lowest in the world. Increasing incidence of cancer, obesity, cardiovascular diseases and HIV/AIDS is likely to slow the rate at which life expectancy increases (AIDS mortality is the highest in the EU, reflecting the relatively widespread use of intravenous drugs).

The proportion of people of pensionable age (65 and over) is forecast to rise from 17% of the population in 2009 to almost 23% in 2030 and even further by 2050. This will place an increased burden on public expenditure in areas such as healthcare (at a time when Spain faces an almost unprecedented period of public spending restraint in order to restore stability to its public finances). Significant immigration in the last decade will alleviate the problems associated with an ageing population profile, but will not resolve them. These trends will put an enormous strain on the healthcare and pension systems. In contrast with many other EU governments that have taken measures to limit pensions and increase the retirement age, the Spanish government has yet seriously to address these issues.