The private sector manages 48% of the country’s total healthcare expenditure to 63.6 billion euros.
● Almost 33,433 million corresponds to healthcare spending on healthcare provision: hospitals, clinics, laboratories and outpatient care.
● The sector employs 462,400 professionals in 2024, the highest number employed since records began and an increase of 53% compared to 2015.
● The average prices are 44% lower than the public ones.
● Carlos Rus: ‘Our weight in the country as a whole makes it unfeasible to make health policy decisions that turn our backs on a sector with so much health expenditure, so many patients and professionals, and which provides so much innovation’.
The private sector is close to 50% of the management of healthcare spending in Spain (public and private), as shown in the II Report ‘ASPE: Analysis of Spanish Private Healthcare 2024’, presented by ASPE in relation to the latest accessible data from 2022. Total expenditure was 63,617 million euros, 48.2% of the total, including the activity of hospitals, medicalised and residential establishments, outpatient care providers, medical product providers, public health programme provision, general health administration and health insurance and other branches. Meanwhile, public health care accounted for expenditure of 68.367 billion euro (total health care expenditure in the country was 131.984 billion euro).
Looking at the weight of each provider in the expenditure managed by the private sector (63,617 million euros), among the main activities, hospitals accounted for 20% of total private healthcare expenditure (12,824 million euros), medical and residential care facilities for 6.5% (4,132 billion euros), outpatient care provision for 26% (16,477 billion euros) and retail and medical product providers for 43.8% (27,879 million euros).
Expenditure financed exclusively by the private sector (direct payments by households and health insurance companies) amounted to 37,289 million euros, representing 28% of the country’s total health expenditure (public and private) and accounting for 3.1% of GDP. Within this item, household payments account for 73% and health insurance for 24%.
As for the health provision sector, including hospitals, clinics, laboratories, nursing homes and outpatient care, the sector’s activity figure amounted to 33,433 million euros, accounting for more than half (52.5%) of private management of total health expenditure.
Shorter waiting times
70% of patients who use private health care wait less than 15 days between the prescription of the surgical operation and the intervention; 26.4% wait less than 6 days. These waiting times are significantly lower than those recorded in the public health system. According to health data as of June 2024, the average waiting time for surgery nationwide is approximately 121 days.
In terms of diagnostic tests, 81% of patients in the private sector wait less than two weeks and almost half of them have their results in less than 5 days. In the public sector, the average waiting time for a diagnostic test is 94 days.
‘These data demonstrate the agility and efficiency with which the private sector works and confirm that private healthcare is a fundamental ally in the Spanish healthcare system,’ says Carlos Rus, president of ASPE.
Increase in high complexity
The report also reveals a significant increase in the number of highly complex tests performed in private centres, rising from 4,403,571 tests in 2021 to 4,742,770 in 2022, i.e. an increase of 7.7% in just one year. This increase occurs in each of the diagnostic tests with high-tech equipment (magnetic resonance imaging, PET, CT, SPECT, gammagraphy, mammography and digital angiography), with 49% of MRI scans, 39% of mammograms and 24% of CT scans in the Spanish healthcare system as a whole, among others.
In terms of healthcare activities, the hospital sector carries out 42% of surgical interventions, 34% of emergencies and 30% of consultations, stays and discharges in Spain. It also carries out 100% of proton therapy sessions, 25% of linear accelerator sessions, 23% of interventional radiology, 22% of haemodynamic studies and 9% of home hospitalisation.
Hospital sector infrastructure
Catalonia is the Autonomous Community where the private hospital sector has the greatest weight, with more than half of all healthcare activities in Spain, followed by the Balearic Islands and Madrid. Cantabria, Castilla-La Mancha and Extremadura are the regions with the least private activity.
The private hospital sector has 431 hospitals (56% of the total number of hospitals), 49,837 hospital beds (31% of the total) and 5,977 ICU beds (20% of the total). Private hospitals also have 1,696 operating theatres (36% of the total), with Catalonia, Madrid and Andalusia having the largest number of operating theatres in private hospitals.
‘We must remove the stigma that the private sector only provides ‘the easy stuff’, because the data corroborates the opposite,‘ says the president of the employers’ association.
Public-private network agreements and average prices
In 2022, the amount of the item of agreements with the public administration (private provision and public service) reached 9,521 million euros, which represents 10.1% of healthcare expenditure. The percentage allocated by the public health administration to this item in relation to total public health expenditure has fallen in recent years, from 11.6% in 2013 to 10.1% in 2022.
Looking at per capita expenditure, Catalonia (€423/per capita), Madrid (€204) and the Canary Islands (€136) are the regions with the highest per capita expenditure on concerts, while Cantabria (€63), La Rioja (€59) and Castilla y León (€57) are the lowest.
The breakdown of the items of the activity of concerts is as follows: hospital services (61%), specialised services (17%), transfer of patients (13%), primary health services (5%) and prostheses and therapeutic appliances (3%).
In this sense, the contribution to the public network is fundamental from the perspective of the prices at which it provides its services. According to the data collected, contracted prices are 44% lower than public prices, based on a national average for surgical and diagnostic procedures. On average, prices for surgical, diagnostic and special procedures are 31%, 50% and 52% lower, respectively. For example, a hip replacement is 46% cheaper, a PET scan 69% cheaper and a restrictive gastric laparoscopy 69% cheaper.
‘Health care agreements are key to reducing the pressure on the public health system, providing greater availability of resources, shortening waiting times for patients and relieving the overload on hospitals and public centres,’ stresses Carlos Rus.
Healthcare professionals
Private healthcare will employ more than 462,400 professionals in 2024, the highest number employed since records began and an increase of 53% compared to 2015. Of all professionals, 159,042 (34%) work in hospitals (33% doctors, 19% nurses, 29% other healthcare professionals and 19% non-healthcare professionals). In the field of training, the number of hospitals with teaching accreditation increased by 46% (from 60 to 88), with Catalonia and Madrid standing out, and the number of accredited MIR places increased by 57% (from 339 to 533), accounting for 5% of the MIR places offered.
