Spain: #19 in the 2024 World Index of Healthcare Innovation

Introduction

Spain has improved its position in the 2024 World Index of Healthcare Innovation, inching up to 19th overall from 21st in 2022. It achieved mostly respectable rankings in various dimensions, including 20th in Quality, 12th in Choice, and 19th in Science and Technology.

On the other hand, Spain was 25th in Fiscal Sustainability. The economic downturn between 2009 and 2015 saw Spain’s per capita GDP decrease by 20 percent. However, subsequent years have witnessed a steady economic rebound. Currently, Spain allocates about nine percent of its GDP to health expenditure. Additionally, Spain boasts a high life expectancy in the European Union at 82 years, surpassing the EU average by two years. This high life expectancy has resulted in a larger population of older adults enduring chronic health conditions and the challenges associated with advanced age, placing upward pressure on public health expenditures.

Background 

Spain’s national health system, the Sistema Nacional de Salud (SNS), is organized at both the national and regional levels. At the national level, the central government is responsible for setting overarching healthcare policies, laws, and regulations. The 17 autonomous communities of Spain are entrusted with the local administration and delivery of healthcare services, allowing them to adapt to the unique health needs and demographics of their respective regions.

Public funding remains the principal source of healthcare financing in Spain, contributing approximately 72.5 percent to the total healthcare expenditures in the latest fiscal year. This reflects a modest increase from the previous year’s 71.1 percent, highlighting a trend towards slightly greater public investment in health services. Despite this, private out-of-pocket expenditures are notably higher than the EU average, representing about 29 percent of total healthcare spending. The co-payment system in Spain is income-dependent, ensuring that costs are scaled according to an individual’s earnings and the nature of the medical service provided.

In 2024, approximately 28 percent of the Spanish population held supplemental private health insurance, a slight increase from the previous year. This includes 82 percent of civil servants, who typically opt for private plans to cover non-essential services and achieve faster access to medical care. Private insurance increases the ability to offer expedited access to specialists and elective surgeries, which can often be subject to longer wait times under the public system.

Spain’s healthcare services are funded and provided by the government through taxes. This system guarantees universal coverage and no-cost access at the point of delivery for most healthcare services. However, the system faces challenges such as varying waiting times for certain treatments across regions and occasional disparities in the availability of services. In response to these challenges, the private healthcare sector has grown, complementing the public system by providing additional options and reducing wait times for insured individuals.

This dual approach to healthcare, combining robust public provision with supplementary private options, facilitates comprehensive coverage and choice, catering to the diverse needs of the Spanish population.

Dimension Performance

Quality

Spain’s performance fell below the median in several key healthcare categories, placing 20th in Quality. This score includes 18th in both patient-centered care, with a high level of patient safety but little transparency in costs and patient outcomes. It also ranked 18th on infrastructure, with efficient use of hospital capacity but shortages of both primary care doctors and nurses. 

However, Spain demonstrated strong capabilities in disease prevention, ranking 10th, due to low rates of treatable mortality and a low rate of hospital admissions.

Choice

Spain ranked near the median for Choice at 12th. Spain achieves universal coverage through a single-payer system, The country placed 12th for access to new treatments, performing fairly well on making new drugs available and at the same time struggling to grow generic drug market share. Spain improved slightly to 14th in freedom to choose healthcare services from its 16th-place rank in 2022.

Science and Technology

Spain holds the 19th position in the Science and Technology rankings. It ranks 17th in medical advances, relying on the European Union’s centralized drug approval system but struggling to muster private R&D investment or development of health care patents. It also finished 21st in scientific discoveries, with no Nobel laureates in medicine or chemistry in the last 20 years and a below-average amount of cited scientific research. The country’s implementation of electronic health records and other technological advancements in healthcare has placed it at 16th in health digitization, reflecting a solid rate of electronic health record use but a below-average use of broadband technologies by the population.

Fiscal Sustainability

Spain’s economic challenges during the Great Recession, particularly its significant debt-to-GDP ratio, are reflected in its below-average rankings in the Index. It placed 25th in fiscal sustainability and 26th in national solvency. Moreover, Spain’s ranking for public health spending was slightly below the median at 21st. Notably, the growth of Spain’s public health spending declined significantly, dropping from 6th in 2022 to 17th in 2024.