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Chart 34
HIGH-TECH EQUIPMENT IN PRIVATE HOSPITALS, 2022

392

303 293

115 109
68
57 56 46
37

MRI CT scan MAMO ASD HEM ALI LIT GAM SPECT PET

Source: Ministry of Health, National Catalogue of Hospitals 2023

Chart 35
HIGH-TECH EQUIPMENT IN PRIVATE HOSPITALS BY REGION, 2022

376

268

190
131
81 77 65 58 55
35 35 31 27 25 14 5 3

Galicia
Madrid

Aragon
Catalonia

Cantabria
Andalusia

Rioja
Canary
Islands

Estremadura
Country
Basque
Community

Balearic
Valencian

Islands
the

Castile
Leon

President
and

Asturias
Region
Murcia

Mancha

Navarre
Castile-

Council
Foral
of

of
Source: Ministry of Health, National Catalogue of Hospitals 2023

La

of
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Chart 36
GEOGRAPHICAL DISTRIBUTION OF HOSPITALS OF THE MAIN HOSPITAL AGENTS

Source: Ministry of Health, National Hospital Catalogue, 2023

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1.4.
Healthcare professionals and training places

Chart 37
ESTIMATION OF PROFESSIONALS IN THE PRIVATE CARE SECTOR, 2022

Intrahospital Outpatient care Total

16.196 52.856 69.052

Doctors Doctors Doctors

29.282 45.774 75,056

Nurses Nurses Nurses The private healthcare sector is
a driving force behind employment
74,096 82.021 156.117 in our country
Others Others Others

119,574 180.652 300.226

Professionals Professionals Professionals

Catalonia, Madrid and Andalusia are, respectively, the autonomous

communities with the highest number of workers.

Source: Prepared by the authors based on data from the Ministry of Health, Specialized Care Information System, hospitals: Personnel and Training, year 2022; Institute
National Statistics, Registered Health Professionals 2022

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Chart 38
GEOGRAPHICAL DISTRIBUTION OF ACCREDITED PLACES IN SPECIALIZED HEALTH TRAINING BY THE RESIDENCY SYSTEM IN PRIVATE CENTERS, 2024

Onkologikoa Fundazioa Foundation University of Navarra Clinic (44

(3 seats) places)

UDM Quiron-prevention (1 place)

Jove Hospital (1 place) UDM San Juan de Dios (2 places)

1
3
11 44
Povisa Hospital (Ribera Salud) (9 beds)
UDM Chironprevention (2 places) 3 102
Althaia Foundation (17 places)
Puigvert Foundation (5 places)
Mollet Hospital (2 places)

Jimenez Diaz Foundation (78 places) 103 CETIR Medical Center (1 place)

Saint John of God (1 place) Sagrat Cor University Hospital (7 places)

Quirónsalud (6 places) Barraquer Oftalmology Center (5 places)

1 Institut Univeristari Dexeus (5 places)
HM Hospitals (8 places)
Sanitas Group (5 places) Saint John of God (34 places)
4
FREMAP (2 seats) Asepeyo Sant Cugat Hospital (1 place)

Asepeyo Monographic Hospital (2 places) 1 Hospital of Sant Pau and Santa Tecla (1 place)

La Fraternidad Prevention and Rehabilitation Center (1 vacancy) Private Foundation Hospital Asil de Granollers (1 place)
Sant Joan de Déu Palma
Mútua de Terrassa University Hospital (2 places)
de Mallorca (1 place)
Palamós Hospital (2 places)
Figueres Hospital (2 places)
HM Nens Hospital of Barcelona (1 place)
UDM Chironprevention General University Hospital of Catalonia (5 places)
(1 place)
Institute of Ocular Microsurgery (1 position)
The 272 places accredited in specialized health Benito Menni (4 seats)
training by the residency system in private centers Valencian Institute of Oncology Foundation (3 places) Pere Mata Institute (6 places)

are distributed among 10 Autonomous Communities, of Nisa Hospital 9 de Octubre (1 place)

which the Community of Madrid and Catalonia reach Source: BOE Order SND/990/2023, of August 17

103 and 102 places respectively.

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The private sector offers a Chart 39

EVOLUTION OF THE DISTRIBUTION OF PLACES IN SPECIALIZED HEALTH TRAINING BY THE SYSTEM OF
total of 272 places in RESIDENCY, 2019-2024

specialized health training 11.879

11.171
10.630 272
10.249 277
9.539 261
254
8.520 215

In 2024, the maximum number of places 171

offered since 2019 has been reached, standing at

11.607
11,879 places. 10.894
9.988 10.376
9.324
8.349
The private healthcare sector is aware of the
importance of training and the needs of the sector.
Private + Public Private
Year after year, the private sector offers places in healthcare management
training. Since 2019, the offer of training has
2019 2020 2021 2022 2023 2024 Publics
increased by 59%.
private training places.
Source: BOE Order SND/990/2023, of August 17

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Table 3
ACCREDITED PLACES FOR SPECIALIZED HEALTH TRAINING IN PRIVATE HEALTH CENTERS, 2024

Pediatrics and specific areas 27

Psychiatry 22

Internal medicine 20
Total
Orthopedic surgery and traumatology 18

Obstetrics and Gynecology 18 272

15
squares
Anesthesiology and resuscitation

Radiodiagnosis 13

Ophthalmology 12

Medical Oncology 10

General and digestive system surgery 7

Occupational medicine 7 In 2024, the private health

Urology 7 sector offered 272 training places,

6
being Pediatrics and specific
Digestive system

6
areas (27),
Medical-surgical dermatology and venereology
Psychiatry (22) and Internal
Nuclear medicine 6
Medicine (20) are the specialties
Nephrology 6
with the highest number of available
Other specialties 72
places
Source: BOE Order SND/990/2023, of August 17

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1.5.
Private investigative activity

Year after year, the private healthcare sector is committed to research in Investment in research and development in the pharmaceutical
the health field. In this regard, it is worth noting that in 2023, the private industry continues to grow and in 2021 reached 1,267 million
healthcare sector has grown in the number of centres that carry out euros, according to data provided by Farmaindustria.
research activities, and continues to invest in research, since 60.7%
of clinical trials were carried out in private centres.
In the period 2016-2023, a total of 137 private centres have participated
in the development of a clinical trial, which represents 30% of the total
The Best report, promoted by the pharmaceutical industry and which number of centres. These centres have participated in some way in 948
includes the research activity carried out by both public and private clinical trials. Of the clinical trials in which private centres participated, 47%
centres, seeks to highlight the research capacity of our country. The latest are clinical trials in early phases.
update of this report published by BDMetrics in March 2024 highlights
the growing support of private healthcare for national research
activity. In a complex context of healthcare innovation, in which the way of developing Finally, it should be noted that private centres have mainly participated
this activity is changing based on in clinical trials in the field of oncology (44.4%), followed by neurosciences
In the context of more collaborative and open environments, and in which the (8.2%), respiratory (7.0%), haematology (6.0%) and vaccines (4.9%).
pandemic has conditioned priorities and committed resources, it should
be noted that according to the latest report published by Farmaindustria,
Spain has positioned itself among the countries in the world with the best

Private centres have conditions for the development of clinical trials of medicines. In addition, it Oncology, neurosciences,
should be noted that, in 2022, more than 900 studies were launched,
participated in 948 clinical of which more than one in four are focused on researching rare respiratory and hematology
diseases.
trials since 2016, which are the main therapeutic
represents just over 50% of areas of the trials with
the total. Private healthcare, the participation of private
key in research centers

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Recruitment Chart 40
RESEARCH ACTIVITY BEST STUDY, PERIOD 2016-2022*

Private centres show excellent results in terms of the

Private % Private
execution and management of clinical research, as
shown in the data in the graph. Number of centers 137 30.0%

Number of clinical trials 948 50.4%

Research
Number of shares 1.661 11.9%
activity
Number of early phase clinical 470 47.0%
trials (LA, LB, LL)

Private healthcare Public health

Patient recruitment month 0.88 0.88

Patients
Recruitment rate 121.1% 108.4%

Evolution of the recruitment rate

108.4%

96.5% 93.5%
94.2% 83.0% 68.6%
84.1%
69.1%

121.1%
113.3%
99.9% 102.6%
90.6% 95.8% 90.5% 92.1%

Public centers
Private centers
2016 2017 2018 2019 2020 2021 2022 2023*

Source: 34th BDMetrics issue. March 2024

(*) Note: The data is provisional, as it only includes recruitment until June 2023

PRIVATE HEALTHSECTOR
PRIVATE HEALTH SECTOR OBSERVATORY
OBSERVATORY 2024
2024 -
- ADDING VALUE ADDING VALUE I Situation analysis Situation analysis 38
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1.6.
Recognition and quality in the private
healthcare sector

In order to improve and demonstrate the quality of its ISO certification for quality management European model of excellence Certifications or quality seals from Joint commission

centres, the private healthcare sector has different (9001), environmental management EFQM autonomous communities:
Accreditation
certifications that accredit the quality of these: (14001), information security (27001),
occupational health and safety (45001) (European Foundation for Granted by the autonomous
Quality Management) communities themselves, they guarantee the
quality of the institutions that have these
(International Organization for certifications or seals.
Standardization)

The Madrid Excelente seal and the ACSA

(*) Note: details of the definition of certifications in the Methodology section
Certification (Health Quality Agency in
Andalusia) stand out, among others.

The private healthcare sector has

various certifications that accredit the
quality of its centres

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Chart 41 Chart 42
NUMBER OF ENTITIES WITH QH RECOGNITION, 2015-2023 NUMBER OF PRIVATE ENTITIES WITH QH, 2015-2023

170 centers with QH recognition

Type of center QH QH* QH** QH*** Total

Private hospitals 20 19 13 15 67

Other specialized centers and 17 39 2 - 58 3

private clinics 7
Public Hospitals 6 7 10 7 30 2
12
Other Publics 1 2 1 - 4 4
2
Mutuals - 1 3 7 11

Total 44 68 29 29 170 32
Source: IDIS Foundation, QH recognition 4
1 13

The IDIS Foundation recognises excellence with It provides a unifying element for the available quality 6
the QH-Quality Healthcare Recognition , the systems and is not intended to replace them.
aim of which is to promote continuous
27
improvement in healthcare organisations, both
public and private. It establishes an identification It makes a voluntary evaluation tool available to 12
everyone free of charge.
through a progressive system from the level of
access to the system (QH) to the highest level
It represents an engine of innovation and continuous
(QH + 3 stars).
improvement.
Source: IDIS Foundation, QH recognition
It recognizes those institutions that strive
Provides visibility to healthcare organizations for
to implement a progressive and continuous
their quality results.
quality system over time and that have obtained
the necessary certifications to do so.

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1.7.
Social impact

End of poverty Health and wellness Quality education

Entities belonging to the private healthcare sector carry out The private sector is actively working to eradicate Private healthcare shows a firm commitment to promoting
various initiatives aimed at a wide range of diseases. It is also concerned excellent education, especially focused on students and
eradicate poverty, including: collaborations with with improving access to medical services and promoting experts in the healthcare field. In 2024, 272 places have been
NGOs, donations of medical supplies, volunteer healthy living in society. made available through the residency programme in
and cooperation projects, etc. private institutions.

Gender equality Decent work and economic growth

In terms of gender equality, the private healthcare In recent years, the private healthcare sector has
sector stands out for its high female representation in generated a significant amount of indirect and induced
leadership roles. employment, mainly within the healthcare sector and its
Private healthcare entities are characterized by being large supply network.
employers of women and by promoting the development A large proportion of these jobs are permanent,
of female talent in with a total of 300,226 professionals employed in both
all organizational hierarchies. However, it is a sector that hospital and outpatient settings.
always supports equality between women and men.

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Industry, innovation and infrastructure Reducing inequalities Responsible production and consumption

The private healthcare sector carries out research and The private health sector has different lines of work to The private healthcare sector recognises the importance of
develops highly complex activities: it participates in just over reduce inequalities, enhance and promote the social, adopting a responsible and efficient approach in the use of
50% of clinical trials, has the latest technology (52% of MRIs, economic and political inclusion of all people. available resources. In this regard, entities in the sector
50% of LITs, 39% of PETs and 33% of CTs) and rapidly To do this, it generates indirect employment for workers have promoted “non-intervention” policies, with the aim of
incorporates new advances. with mental disabilities, grants scholarships to students and avoiding or minimising those practices that do not add
professionals and allows volunteer work, value for patients. Similarly, they have promoted responsible
practices in supply chain management.
inter alia.

Climate action Partnerships to achieve the goals

Caring for and sustaining the environment is a priority for Private healthcare works together with institutions of
private healthcare entities. various kinds, promoting alliances between the public
Insurance and pension institutions have established and private spheres, associations, etc., in addition to having
environmental policies focused on energy savings and other models and innovative formulas for collaboration
emissions reduction. based on new technologies.

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2
Private sector
contribution to the System
National Health
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2.1.
It represents a high weight in the
between the different regional organisations that make up the National
Spanish productive sector
Health System (NHS). It is the perfect source for analysis and comparisons
between autonomous communities.

The OECD and the Ministry of • The OECD uses the System of Health Accounts (SHA) to collect
Health authorities have different information on health expenditure, as do other international entities
such as Eurostat and the World Health Organization (WHO). The
methodologies for calculating health collection and calculation methodology has been designed and
agreed upon by the member countries that make up these
expenditure, which means that there organizations, so that this information allows for analysis and

are certain differences between both comparisons of expenditure between countries. This information
includes both public and private expenditure, without considering how the
sources. health systems of each country are organized.

This section analyses Spanish health expenditure from a macroeconomic

It is important to remember that the EGSP does not include the expenditure
perspective, as well as enriching the analysis by comparing the situation in
of public entities whose main activity is not healthcare and which do not develop
Spain with that of other OECD member countries. By delving deeper into the
programmes included in the health function of the General State Budget.
data, the reader will be able to see differences between those provided by the
Therefore, the ESGP does not consider healthcare expenditure made by
Ministry of Health (2021) and those of the OECD for the same year.
public entities within the framework of social and healthcare care1,
Specifically, the OECD presents 4,801 million euros more expenditure than
specifically:
the Ministry of Health. These differences lie in the methodology applied for
its calculation. Expenditure related to long-term care.

The differences between the two data sources used for the analysis of Convalescent health care expenditure.
health expenditure - OECD and the Public Health Expenditure Statistics (EGSP)
of the Ministry of Health - lie in the estimation method. Specifically, the Rehabilitation expenditure in patients with recoverable functional
differences are due to: deficit.

• The EGSP considers expenditure incurred or financed by public health However, these expenses, as well as private health care expenses, are
agents. Its calculation methodology has been agreed considered in the SCS.

(1) Law 16/2003, of May 28, on cohesion and quality of the National Health System

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Historically, healthcare expenditure in Spain has been around 9% of Gross Chart 43

Domestic Product (GDP), but in 2021 it increased to 10.7%. However, variations are EVOLUTION OF TOTAL HEALTH EXPENDITURE IN SPAIN IN RELATION TO GDP, 2011-2021
observed in absolute terms over time.

% Private
26.5 27.9 29.0 29.7 28.7 28.4 29.5 29.8 29.5 26.9 28.4
In 2021, public health expenditure accounts for 71.6% of total health expenditure, spending

while the remaining 28.4% comes from private health expenditure. It is noteworthy
that, during this year, the share of private health expenditure has experienced a
slight increase compared to the previous year, thus approaching previous levels. % of GDP 9.2 9.2 9.1 9.1 9.1 8.9 8.9 9.0 9.1 10.7 10.7
This change is mainly attributed to the impact of the COVID-19 pandemic on public
expenditure.

% Public
73.5 72.1 71.0 70.3 71.3 71.6 70.5 70.2 70.5 73.1 71.6
spending

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Note: Historical data correspond to the latest available updates from the OECD Source: OECD. Health Data 2021. Accessed February 2024

Health expenditure in Spain

is equivalent to 10.7% of GDP, with
private health expenditure accounting
for 28.4% of this total.

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Total health expenditure in Spain, which amounts to 10.7% of GDP,

continues to increase and is increasingly closer to the average of
OECD countries, remaining just 0.2 points behind.
Germany and the United Kingdom lead in this regard, with
healthcare spending representing 12.9% and 12.4% of their respective GDPs.

Chart 44
Total health expenditure in PERCENTAGE OF TOTAL HEALTH EXPENDITURE TO GDP IN SELECTED OECD COUNTRIES, 2021

relation to Spain's GDP is close to Total on

12.9
GDP
the average of the 12.4 12.3 12.1
11.6 Private
11.3 11.2 11.1 11.0
1.9 10.9 10.8 Public
OECD, while the weight of private 2.1 1.9 2.6
10.7

3.6 1.7 1.6 9.5 9.4

4.1 2.5 23
health expenditure in relation to 11.1
10.3 10.4
1.6
3.1

GDP is one of the highest, 9.5

9.6
9.7
9.2
1.3
23 6.4
8.0 8.6 8.7
7.7 8.2
reaching 3.1%, together with 7.0 7.1 1.8

Portugal (4.1%) and Switzerland 4.7

(3.6%)

Netherlands

Denmark
Kingdom
Germany

Republic
Portugal

Belgium

average
Sweden
France

Austria
United

Poland
OECD

Czech
Spain
Swiss

Italy
(P)
Source: OECD. Health Data 2021. Accessed February 2024

Note: (P) indicates that the data are provisional.

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Since 2011, private healthcare spending in Spain has seen a Chart 45

steady increase, peaking in 2021 at a total of €36.805 billion. EVOLUTION OF PRIVATE AND PUBLIC HEALTH SPENDING IN MILLIONS OF EUROS, 2011-2021

129.615
During the period 2011- 120.135
113.911
In 2021, the compound annual 103.984
108.310
36.805
98.344 99.710
97,525 32.263
93,811
growth rate (CAGR) for private 94,389 92.514
32.250
33,549
30.667
28.365
healthcare expenditure was 3.59%, 25.860
26.327 26.823 27.896
28.209

while the rate for public

healthcare expenditure was 76.060 80.362
87.873 92.810

71,666 70.135 71,346 73,317

68.062 65.691 65.915
2.62%. Both rates show positive
and steady growth throughout this
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
period.
CARG +3.59% CARG +2.62% Private spending in M€ Public spending in M€

In 2021, public health expenditure experienced a significant increase Source: OECD. Health Data 2021. Accessed February 2024

compared to the previous year, reaching 92.81 billion euros.

Note: Historical data correspond to the latest available update from the OECD

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In 2021, spending on collaboration between the private and public sectors

reached 9,227 million euros, which includes public spending generated by The total expenditure
private assistance. Of this total, 7,097 million euros (76.9% of the
total) come from the autonomous communities, 1,505 million euros from
on private health and
mutual societies, and 408 million euros from Social Security.
private-public
collaboration
(concerts) amounts to
Chart 46
COMPOSITION OF PRIVATE-PUBLIC COLLABORATION EXPENDITURES, 2021 €46,032 million, which
translates into 3.81% of GDP
% Variation 2020-2021

Security
Social
Of the 0.76% of GDP that makes up healthcare
0.03%
expenditure on private-public collaboration in
Private 408 M€
Spain for 2021, 0.59% comes from the
11.7%
3.05% autonomous communities, 0.12% from mutual
3.81%
of GDP 36.805 M€ Mutual Societies insurance companies and 0.03% from Social Security.
14.5%
0.12%
1.505 M€
1.3%
Collaboration
private-public
0.76%
9.227 M€ Communities
autonomous
7.6%
0.59%
7.097 M€
Public 8.4%

6.93%
83.583 M€
5.2%

Methodological note: The value of public health expenditure comes from the subtraction of the value of public expenditure from the OECD,
Health Data 2021 and the value of expenditure on concerts from the EGSP of 2021. Private expenditure has also been taken from the OECD
Source: OECD. Health Data 2021; Ministry of Health. Public Health Expenditure Statistics

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According to the data provided by the Ministry of Health, Chart 47

public health expenditure in 2022 has reached a new high, EVOLUTION OF PUBLIC HEALTH EXPENDITURE IN MILLIONS OF EUROS AND IN RELATION TO GDP ACCORDING TO
reaching 92,072 million euros. Public health expenditure as a STATISTICS ON PUBLIC HEALTH EXPENDITURE (EGSP), 2012-2022
percentage of GDP has decreased slightly in 2022 (6.8%)
compared to 2021 (7.2%), but remains at higher levels than +3.38% +4.93%

in the 2012-2019 period. 92.072

83.624 88.009
74.977
71.112 Spending in €
65,764 66,717 68,529
64.114
Spain's public health 61,726 61,973
Spending
in % of GDP

expenditure in 2022 has

reached €92,072M, of which 7.5 7.2 6.8
6.2 6.0 6.0 6.1 6.0 5.9 5.9 6.0
10.2% was allocated to
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
private-public collaboration
Source: Ministry of Health. Public Health Expenditure Statistics.

(concerts)
Chart 48
In 2022, private-public collaboration (concerts) reached a value COMPOSITION OF PUBLIC HEALTH EXPENDITURE, 2022
of 9,521 million euros (10.1%), of which 79% is concentrated
26.6% 16.9% 9.521
in the following items: Current transfers 3% (247)
Intermediate Intersectoral
5% (511)
consumption 10.1% transfers
13% (1,265)
Private-public
Hospital services* (62%), which include both hospitalization Primary health services
collaboration 17% (1,637)
and diagnosis, treatment (such as dialysis), surgery (major
Transfer of
or minor) without hospitalization, consultations and
sick people
emergencies
Services
3.5% 62% (5,862) specialized
and specialized assistance services* (17%) contracted 42.6%
Staff remuneration Capital expenditure Hospital
for the performance of activities specific to this level of care with
0.4% services
assets outside the entity that finances the care Consumption of fixed capital

*Definitions taken from the document “PUBLIC HEALTH EXPENDITURE STATISTICS 2022: Main results” Source: Ministry of Health. Public Health Expenditure Statistics.

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2.2.
Free up resources and improve accessibility

The data published by the Ministry of Health show an

Chart 49
upward trend in health expenditure per capita. A projection of
ESTIMATION OF THE EVOLUTION OF PUBLIC AND PRIVATE HEALTH EXPENDITURE PER CAPITA, 2020-2023
this trend is estimated for 2023, where public
expenditure stands at 2,101 euros per capita by applying
the average deviation produced in the period from 2017 to
2022.
2.800 699
674
2.613 645
2.502
2.338 575
Public spending per capita in 166
181
195

2023 stands at 2,101 155

2.101 Public spending per capita Assurance
Euros 1.939 per capita
1.857
1,762

In the last four years, private spending per capita has shown
an increasing trend, reaching 699 492 503
479
euros. 420

Private health expenditure per capita is divided into out-of-

575 645 674 699 Private spending per capita Pocket per capita
pocket expenditure and insurance expenditure, which in 2023
amounted to 195 euros and 503 euros respectively.
2020 2021 2022 2023 (E)
2020 2021 2022 2023 (E)

Source: Ministry of Health. Public Health Expenditure Statistics; Initial budgets adjusted by the average deviation produced in the period 2017-2022; INE: Municipal register and
family budget statistics; ICEA Health Insurance 2024
Note: Public health expenditure in 2023 is an estimate, resulting from applying the average deviation in the period 2017-2022 (9.7%).

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The estimate of per capita health expenditure for 2023 places

Chart 50
Catalonia (3,264 euros) as the region with the highest
ESTIMATION OF PUBLIC AND PRIVATE HEALTH EXPENDITURE PER CAPITA BY AUTONOMOUS COMMUNITY, 2023
expenditure, followed by Murcia and the Basque Country.

Estimated private expenditure per capita

Estimated public expenditure per capita

Catalonia becomes the 3.264

3.094
community with the 2.983
2.835
854 534 2,824 2,800 2,789 2,737 2,687 2,673 2,649 2,641
2,593 2,588 2,546 2,513
highest health expenditure 715
701 741 699 695
2.414
2.218
851 608 598 598
per capita (€3,264) 684 803 736
552
748 571
618

2.410 2.560
2,268 2,134 2,083 2.101 2.094
1.886 2,079 2,075 2,051 1.957 1,790 1.852 1.994 1.765 1,843
1,600

Galicia
Madrid
Aragon
Catalonia

Cantabria

Andalusia
Rioja
Canary
Islands

Estremadura
Country
Basque

Community
Balearic

Valencian
Islands
the

Castile
Leon

President
and

Asturias
Region
Murcia

Mancha
Navarre

Castile-
Council
National

Foral
of

of

La
of
Source: Ministry of Health. Public Health Expenditure Statistics; Initial budgets adjusted by the average deviation produced in the period 2017-2022; INE: Municipal register
and family budget statistics; ICEA Health Insurance

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PRIVATE SECTOR CONTRIBUTION TO THE NATIONAL HEALTH SYSTEM P 1 2 3 4 5

10.7 million insured people Chart 51

SUBSTITUTIONAL COST FOR PRIVATE INSURANCE, 2023
contribute to the reduction of the
burden on the public health system
Companies spend €624 per insured person on assistance:
and the improvement of the SNS
10,742,468 624* =
In 2023, a total of 10.7 million insured persons were registered, not Beneficiaries
x
Euros/beneficiaries
6.701 M€
counting public health mutual funds. The population with private
insurance contributes greatly to unloading the public health system,
since by having double insurance (public and private) they do not
consume, or do so only in part, resources from the public system.
The calculation of the investment made by the insured in Health is
shown in the graph.

The cost of investment in health

through private insurance is
estimated at 6.701 billion euros,
depending on the claims made by
insurers. (*) Note: the breakdown and calculation of the amount related to the replacement cost for the use of private insurance is €624/ beneficiary and is explained in the
methodological notes section.
Source: ICEA health insurance, 2024 and EGSP 2022

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2.2.1. Health care

Chart 52
NUMBER OF HOSPITALS AND BEDS BY CARE PURPOSE, 2022

597

273
46%

248
324 165
54% 67%
83
Hospitals 33%

General and Other purpose

specialized

128.350
31,711
25%

96,639
75%

30.699 18,863
61%

Beds 11,836
39%

General and Other purpose

specialized

Private Public

Source: Ministry of Health, National Catalogue of Hospitals 2023

Note: The number of public hospitals differs from Chart 22 since this counts individually the hospitals belonging to complexes.

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Catalonia is home to the vast majority of centres in the Public Table 4

Hospital Network (RHUP), with 98 out of a total of 104 centres. As for DISTRIBUTION OF HOSPITALS BY AUTONOMOUS COMMUNITY AND TYPE OF AGREEMENT IN THE PRIVATE SECTOR, 2022
private hospitals, it should be noted that the most common type of
agreement in charitable hospitals is the partial agreement, representing
65% of cases. Public hospitals Private hospitals

Partial Substitute
Total audiences RHUP Without concert
Administrative concession concert concert

Andalusia 34 --
31 --
1 27

Aragon 19 --
6 --
1 4

Foral Council of Navarre 4 -- -- -- --

6

Canary Islands
11 --
15 -- --
8

Cantabria 4 -- -- -- --
3

Castile and Leon 16 --

17 2 --
2

Castile-La Mancha 20 --
6 -- --
2

Catalonia 62 -- -- --
98 43

Ceuta 1 -- -- -- -- --

Valencian Community 39 3 8 1 --
14

Estremadura 10 --
3 --
1 5

Galicia 15 --
12 2 1 3

Balearic Islands 11 --
8 -- --
6

Rioja 4 1 -- --
1 2

Madrid 37 4 29 -- --
20

Melilla 1 -- -- -- -- --

the Basque Country

22 --
15 -- --
5

President of Asturias 12 --
2 1 1 10

Region of Murcia 11 --
14 -- --
2

Total 333 8 166 6 104 162

Source: Ministry of Health, National Hospital Catalogue, 2023

Note: Hospital complexes are counted as a single hospital.

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PRIVATE SECTOR CONTRIBUTION TO THE NATIONAL HEALTH SYSTEM P 1 2 3 4 5

Catalonia is also the autonomous community with the largest number of Table 5
beds, with a total of 34,488 between public and private centres. DISTRIBUTION OF BEDS BY AUTONOMOUS COMMUNITY AND TYPE OF AGREEMENT IN THE PRIVATE SECTOR, 2022

Public beds Private beds

Partial Substitute Public use network

Total audiences Without concert
Administrative concession concert concert (RUP)

Andalusia 17.428 --
4.025 --
15 1.603

Aragon 4.315 --
620 --
39 300

Foral Council of Navarre 1.459 -- -- -- --

954

Canary Islands
4.447 --
2.037 -- --
307

Cantabria 1.385 -- -- -- --
297

Castile and Leon 7.288 --

1.332 457 --
286

Castile-La Mancha 5.321 --

304 -- --
55

Catalonia 14.473 -- -- --
16.491 3.524

Ceuta 246 -- -- -- -- --

Valencian Community 11.592 834 923 117 --

1.310

Estremadura 3.424 --
197 --
45 129

Galicia 7.296 --
1.314 629 84 129

Balearic Islands 2.593 --

648 -- --
785

Rioja 885 87 -- --
26 139

Madrid 14.079 1.031 4.962 -- --

1.894

Melilla 168 -- -- -- -- --

the Basque Country

5.871 --
1,830 -- --
274

President of Asturias 2.912 --

82 233 153 457

Region of Murcia 3.293 --

1.506 -- --
62

Total 108.475 1.952 19,780 1.436 16.853 12.505

Source: Ministry of Health, National Hospital Catalogue, 2023

Note: Hospital complexes are counted as a single hospital.

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PRIVATE SECTOR CONTRIBUTION TO THE NATIONAL HEALTH SYSTEM P 1 2 3 4 5

When analysing the geographical distribution, communities Table 6

such as Andalusia, Catalonia and Madrid have a large weight in DISTRIBUTION OF HOSPITALS AND BEDS BY AUTONOMOUS COMMUNITY (ORDERED ACCORDING TO THE
terms of centres and beds, placing them above the national NUMBER OF PRIVATE BEDS), 2022
average.

Hospitals Beds

Private healthcare is Publics

Private
(beneficial and non-beneficial)
Public
Private
(charitable and non-charitable)

present in all Catalonia* 62 141 14.473 20.015

Madrid
autonomous communities, Andalusia
37 49 14.079 6.856

34 59 17.428 5.643

with Catalonia, Madrid Valencian Community 39 23 11.592 2.350

and Andalusia Canary Islands

11 23 4.447 2.344

Galicia 15 18 7.296 2.156

having the highest the Basque Country

22 20 5.871 2.104

number of hospitals Castile and Leon 16 21 7.288 2.075

(56.8%) and Region of Murcia

Balearic Islands
11 16 3.293 1,568

11 14 2.593 1.433

private beds (64.3%) Aragon 19 11 4.315 959

Foral Court of Navarre 4 6 1.459 954

President of Asturias 12 14 2.912 925

Estremadura 10 9 3.424 371

Castile-La Mancha 20 8 5.321 359

Cantabria 4 3 1.385 297

* Of the 141 hospitals classified as private, 43 are private hospitals
without a contract and 98 are centers that are part of the RHUP/
Rioja 4 3 885 165
XUP; private hospitals without a concert have 3,524 beds and those
belonging to RHUP/XUP have 16,491. Ceuta 1 0 246 0

Source: Ministry of Health, National Hospital Catalogue, 2023 Melilla 1 0 168 0

Note: Hospital complexes are counted as a single hospital.
1 Includes private hospitals integrated into the Public Utilization Total 333 438 108.475 50,574
Hospital Network (RHUP / XHUP)

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PRIVATE SECTOR CONTRIBUTION TO THE NATIONAL HEALTH SYSTEM P 1 2 3 4 5

The private sector plays a relevant

role in the NHS, assuming
a significant part of healthcare
activity. It contributes to freeing
up resources from the public
system and reducing healthcare
pressure, which translates into
better medical care.
Chart 53
CARE ACTIVITY CARRIED OUT BY THE PRIVATE SECTOR IN SPECIALIZED CARE CENTERS, 2021

Healthcare
When evaluating the contribution of the private system, it is activity
essential to consider the activity carried out through

alternative contracts or in centres integrated into public Private Private hospitals not covered by the SNS SNS public
Total hospitals not covered by the SNS* + Private SNS hospitals hospitals
hospital networks (RHUP). If we consider this activity in
Totals Percentage Totals Percentage Total
private centres, we can say that they represent between 29%
and 42% of the total hospital activity of the National Health Highs 4,932,478 1,116,155 22.6% 1,460,809 29.6% 3,816,323

System (NHS). Stays 35,863,126 6.209.016 17.3% 11.200.692 31.2% 29,654,110

Consultations 105.962.800 24,827,439 23.4% 31.480.103 29.7% 81.135.361

As previously mentioned, a slight increase in healthcare Emergencies 27,868,842 7,018,650 25.2% 8,651,558 31.0% 20.850.192
activity has been observed during the 2020-2021 period.
Interventions 4,983,312 1,625,803 32.6% 2,056,408 41.3% 3,357,509
surgical

* Does not include activity in centres with substitute contracts or in the public hospital network (RHUP)
Source: Ministry of Health. Statistics on Specialized Care Centers: hospitals and non-hospitalized centers, 2021.

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Private healthcare Table 7

ANALYSIS OF THE NUMBER OF SURGICAL INTERVENTIONS IN THE PRIVATE SECTOR, 2021

represents approximately
28% to 35% of total Total IQ Private hospitals not covered by the SNS* Private hospitals SNS
Surgical interventions, 2021 (public +

surgical activity private) No. % No. %

With income 1,969,801 689.384 35.0% 814.442 41.3%

In 2021, approximately 5 million surgical interventions were

performed in total. With Major Outpatient Surgery 1,735,551 573,770 33.1% 729.348 42.0%

Other outpatient interventions

Surgical interventions with admission are the most frequent 1,289,060 362,649 28.1% 523,718 40.6%
in private centres. However, the interventions that
represent the highest percentage of the private sector in
relation to the total are those of Major Outpatient Surgery, * Does not include activity in centres with substitute contracts or in the public hospital network (RHUP)
Source: Ministry of Health. Statistics on Specialized Care Centers: hospitals and non-hospitalized centers, 2021.
which constitute 42% of all interventions, including those
carried out in public hospital networks (RHUP), private
hospitals and hospitals with substitute agreements.

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PRIVATE SECTOR CONTRIBUTION TO THE NATIONAL HEALTH SYSTEM P 1 2 3 4 5

Examining discharges and stays for purely private Table 8

healthcare activities, not including substitute agreements NUMBER OF DISCHARGES AND STAYS BY CARE AREA, 2021
or RHUP, differences are observed in the penetration
of private activity.
Healthcare activity Total discharges
Private non-SNS
Total stays Private stays not SNS*
discharges*
% private % private

Traumatology (35.3%) and Surgery and surgical

Medicine and medical specialties 1,981,286 297,040 15.0% 15,521,139 1,876,912 12.1%
specialties (31.5%) are the areas in which the private
sector has a greater weight of discharges compared to the total. Surgery and surgical specialties 1,329,057 418.061 31.5% 5,357,538 909.892 17.0%

Traumatology 568,238 200.468 35.3% 2,316,042 472.404 20.4%

As regards stays , Rehabilitation (35.7%)
and Psychiatry (28.9%) are the healthcare areas in Gynecology and Obstetrics 524,000 124.784 23.8% 1,414,453 290.470 20.5%

which private activity has the greatest weight in Pediatrics 260,367 40.963 15.7% 1,099,681 123.274 11.2%
relation to the total.
Rehabilitation 11.331 2.914 570.540 203.424
25.7% 35.7%

Intensive Medicine 242.292 32.318 1,397,260 167,836

13.3% 12.0%

Long Stay 37.815 3.697 9.8% 2,990,970 694.647 23.2%

Psychiatry 103,638 9.897 9.5% 4,879,416 1,409,929 28.9%

Others 51.525 3.383 6.6% 871.539 8.328 1.0%

Source: Ministry of Health. Statistics on Specialized Care Centers: hospitals and centers without hospitalization, 2021
* Does not include activity in centres with substitute contracts or in the public hospital network (RHUP)

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If we carry out a detailed analysis of the activity

Chart 54
In the surgical sector, we observe that the private SURGICAL ACTIVITY IN PRIVATE HOSPITALS, 2021
sector carries out, on average, 31.6% of the
total volume of activity carried out in 2021, with
notable specialties such as neurosurgery. Surgical interventions % Private non-SNS*

Angiology and Vascular Surgery 33.5%

Private surgical Cardiac Surgery 20.0%

activity reaches up to General and Digestive Surgery 33.9%

41.7% of the total in the Pediatric Surgery 18.0%

field of Neurosurgery. Thoracic Surgery 16.4%

Gynecology and Obstetrics 29.8%

On average, for the Neurosurgery 41.7%

most complex surgical Ophthalmology 23.9%

interventions, the Otorhinolaryngology 29.0%

private sector
Traumatology 36.7%
accounts for
Urology
approximately 32% of all surgeries. 30.3%

* Does not include activity in centres with substitute contracts or in the public hospital network
(RHUP)

Source: Ministry of Health. Statistics on Specialized Care Centers: hospitals and centers without
hospitalization, 2021

PRIVATE HEALTH SECTOR OBSERVATORY 2024 - ADDING VALUE I Situation analysis 60