The healthcare system in Spain is publicly funded, universally accessible, and managed by the National Institute of Health Management (INGESA). Spain ranks among the top OECD countries for clinical outcomes,
Spain ranks among the top OECD countries for clinical outcomes, supported by its universal coverage and emphasis on equity. Life expectancy at birth in Spain reached 83.2 years in 2022, compared to the OECD average of 81.0 years. Infant mortality is among the lowest in Europe, at just 2.5 deaths per 1,000 live births, well below the OECD mean of 4.1. Moreover, around 99% of the Spanish population is covered by the public health system, ensuring broad and equitable access to medical services. This combination of efficiency, accessibility, and strong public trust places Spain consistently within the top quartile of OECD nations for health system performance.
These figures are drawn from official sources, including the OECD’s Health at a Glance: Europe 2024 report, the Spanish Ministry of Health, and the World Health Organization.
With 99.5% of the population enjoying universal access through the public health system. Life expectancy is the highest in the EU, at 83.5 years in 2024, reflecting excellent management of chronic diseases and preventive services. Patient satisfaction is also high; 86% of people with chronic conditions rate care quality as good and 85% describe their care as person-centered, based on OECD PaRIS surveys. Spain’s hospitals perform 3.5 million surgical interventions annually, with nearly 87 million public sector consultations each year, and 48.6% of major surgeries are conducted on an outpatient basis, highlighting system efficiency.
These outcomes are documented by sources such as the OECD Health at a Glance: Europe 2024 report, the OECD PaRIS patient survey, and the Spanish Ministry.
Yes, Spain guarantees universal healthcare for all residents, funded through general taxation. Services are delivered through autonomous communities, ensuring equitable access regardless of income or region.
Spain’s public health system ensures free or low-cost healthcare for all legal residents. It is primarily funded through general taxation and administered regionally by the autonomous communities. The system guarantees universal access to essential services, including primary care, hospital admissions, and emergency treatment, which account for over 70% of total healthcare spending. According to the Federación de Asociaciones para la Defensa de la Sanidad Pública (FADSP),, Spain consistently ranks among the top European countries in terms of equity and accessibility, although regional differences can affect waiting times and resource allocation.
In parallel, Spain’s private healthcare sector complements the public system by offering faster access to specialists, shorter waiting lists for elective procedures, and more comfort-oriented services. Approximately 20% of the population hold private insurance to take advantage of these benefits.
Yes, healthcare in Spain is free at the point of use for residents for most services. Prescription medications require a co-payment that varies by income and employment status. Active workers with incomes below €18,000 pay 40% of the medication cost, those earning between €18,000 and €100,000 pay 50%, and those with incomes above €100,000 pay 60%. Pensioners generally pay 10% with monthly caps that vary according to income, with exemptions for vulnerable groups and those with very low incomes. This co-payment system was reformed in 2012 to link contributions to income, improving fairness and sustainability.
Sources: Spanish Ministry of Health Royal Decrees (RDL 16/2012 and RDL 20/2020)
Healthcare in Spain for expats often involves both public registration and supplemental private insurance. Expats with a valid NIE (Número de Identidad de Extranjero) and social security registration are eligible to access the public system.
Healthcare in Spain for tourists is accessible through the European Health Insurance Card (EHIC) for EU/EEA nationals, covering medically necessary treatments during short stays. Non-EU tourists typically rely on private travel insurance or pay out-of-pocket for services.
The healthcare system in Spain provides universal access to public healthcare for residents, while also supporting private insurance for added convenience and non-residents.
Expats legally residing in Spain can access public healthcare by registering with the social security system (Seguridad Social) and obtaining a healthcard (Tarjeta Sanitaria).
Non-EU citizens must show proof of private health insurance to obtain a residency permit. The insurance must cover 100% of medical expenses without co-payments, as per Spanish immigration law.
EU citizens can use the EHIC card to receive public healthcare during short stays in Spain. Non-EU visitors must rely on private travel insurance or pay directly for care.
All individuals using healthcare services in Spain—public or private—are protected under This legislation guarantees:
Spain’s healthcare system is globally recognized for its exceptional clinical outcomes, robust medical infrastructure, and high standards in patient rights and protections. Public hospitals and private clinics are equipped with modern technology, and Spain consistently invests in the training of healthcare professionals through its top-ranked medical universities.
Spain ranks in the top tier of EU countries for clinical outcomes in key specialties such as cardiology, oncology, preventive care, and chronic disease management. It has one of the lowest avoidable mortality rates in Europe, with 143 preventable deaths per 100,000 population and 62 treatable deaths per 100,000, both below the EU average, according to data from 2020. Cardiovascular diseases remain the leading cause of death (around 33.7% of total deaths), followed closely by cancers, which accounted for 25.9% of deaths in recent years. Cancer survival rates in Spain are comparable to those in Germany and France, reflecting high-quality oncology care.
Preventive care is robust, with state-funded vaccination programs and widespread availability of screening services such as colorectal and breast cancer screenings. These efforts contribute to Spain’s sustained high life expectancy and strong management of chronic conditions like diabetes and respiratory diseases. The country also demonstrates low rates of avoidable hospitalizations, reflecting efficiency in primary and specialized care.
These health outcomes are supported by comprehensive monitoring and public health interventions, making Spain a leading example within the EU for clinical care quality and preventive health services.
All residents and legal users of the public or private healthcare systems in Spain are protected under Spain’s General Health Law (Ley 14/1986, de 25 de abril) and the Patients’ Rights Charter. These laws guarantee:
These protections are embedded in Spain’s legal framework to ensure patient autonomy, confidentiality, and high standards of care. The full text of the General Health Law is available here: https://www.boe.es/buscar/act.php?id=BOE-A-1986-10499
Detailed patient rights and duties are also outlined in the Patients’ Rights Charter, which emphasizes informed consent, non-discrimination, and the right to be truthfully informed in understandable terms. The legislation governs privacy and data protection regarding health records in line with EU regulations, facilitating safe and secure use of EHRs across the National Health System
Yes, Spain has one of the best healthcare systems in Europe, characterized by universal access, low out-of-pocket expenses, and excellent clinical results across multiple specialties. The country is consistently ranked highly by major organizations:
Spain’s strong commitment to patient-centered care, health equity, and continuous quality improvement has established it as a leader in global health service delivery, recognized by both WHO and OECD rankings.
The Spain behavioral health services market is growing through public investment and private care expansion. Mental health is increasingly integrated into the Spain public health system, with access to psychologists, psychiatrists, and community programs.
This dual model ensures broader access and supports Spain’s progress toward integrated, accessible behavioral care.
Spain delivers advanced care in oncology, cardiology, and neurology through well-equipped public hospitals and a thriving private sector. Hospitals utilize robotic surgery, MRI/PET imaging, and genetic therapies for cancer and rare diseases, showcasing advanced medical technologies. The country’s biotechnology sector is robust, with over 800 companies contributing to personalized medicine and diagnostics, according to ASEBIO 2023. The total addressable market (TAM) for biotechnology in Spain is significant with a compound annual growth rate (CAGR) estimated at around 7–9%, reflecting strong sector expansion.
Pharmaceutical exports from Spain reached approximately €18.18 billion in 2024, maintaining Spain’s position among the top exporters in Europe. According to Farmaindustria 2023 data, Spain ranks 5th in pharmaceutical exports within the European Union, trailing major exporters like Germany and Belgium but ahead of countries such as Italy and the Netherlands.
These innovations and exports not only support clinical excellence across key specialties but also strengthen Spain’s economic competitiveness in the global healthcare and pharmaceutical markets.
Sources:
Spain’s public health system ensures broad access to essential medications through a well-regulated and equitable framework. The Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) plays a central role in overseeing the approval, safety, and pricing of pharmaceuticals, ensuring that all medications meet strict standards of efficacy, safety, and cost-effectiveness.
Prescription drugs in Spain are heavily subsidized by the government, making them accessible to most of the population. The co-payment system is income-based, with patients contributing between 10% and 60% of the medication cost depending on their income level, employment status, and age. Pensioners and individuals with chronic conditions often benefit from reduced or zero co-payments, promoting health equity.
OTC medications are widely available through a dense network of community pharmacies, which are the primary point of access for non-prescription drugs. These pharmacies are staffed by licensed professionals who provide guidance on safe medication use, contributing to responsible self-medication practices.
To maintain the financial sustainability of the public health system, Spain implements several cost-containment strategies, including:
Pharmaceutical companies play a foundational role in Spain’s healthcare by advancing science, strengthening the economy, and expanding patient access.
This industrial strength supports not just innovation but also national health priorities and global partnerships.
Spain faces structural challenges in harmonizing universal healthcare access with rapid pharmaceutical innovation.
“Ongoing efforts are addressing these challenges, while the healthcare system continues to guarantee universal coverage for all.”
Pharmaceutical companies, such as Rubió, play a critical role in building a more sustainable healthcare system in Spain through investment in clinical trials, medical education, public health awareness, and environmental responsibility.
Clinical trials funded by pharma reduce the burden on the public health system by offering early access to innovative treatments.
In 2024, investment in clinical trials in Spain reached approximately €900 million, driven largely by the pharmaceutical industry, which funded over 830 million euros of this total. This significant investment supports more than 900 clinical trials authorized across the country, engaging around 170,000 patients in cutting-edge research, including studies focused on cancer, rare diseases, and advanced therapies.
For over 50 years, Rubió has invested in R&D, developing and bringing to market more than 10 medicines, including Value Added Medicines (VAMs). Beyond innovation, Rubió advances medical education by sponsoring training in digital diagnostics and emerging therapies, ensuring healthcare professionals remain equipped with cutting-edge knowledge. The company also supports public health campaigns that raise awareness on managing chronic diseases, ultimately improving outcomes and reducing long-term care costs.
Sustainability is a core pillar of Rubió’s business strategy, integrating environmental stewardship with its commitment to human health. The company prioritizes ecological impact and people’s well-being by applying circular economy principles, investing in renewable energy, and optimizing resources. Rubió’s photovoltaic panels currently generate 15% of its total energy consumption, demonstrating real progress toward net-zero emissions.
Rubió’s sustainability initiatives include:
As outlined in the Rubió ESG Report, these practices not only reduce the company’s environmental footprint but also set a benchmark for responsible innovation in healthcare. Collectively, pharma’s contributions, led by examples like Rubió, enhance care quality, reduce systemic costs, and support the long-term sustainability of the healthcare system.
Spain’s emergency care is coordinated through the national 112 system, offering rapid access to ambulances and trauma care across all regions.
Spain’s blend of public and private systems ensures widespread emergency readiness and specialty care.
With its integrated model and robust regulatory framework, Spain sets a powerful example of public-private synergy in healthcare. Approximately 99.5% of the population is covered by the public health system, which provides comprehensive access to care free at the point of delivery. Spain boasts the highest life expectancy in the European Union at 84.25 years in 2025, significantly above the EU average of 81.4 years, reflecting the strong impact of its healthcare model on citizens’ health outcomes.
Spain spends around 10.7% of its GDP on healthcare, which is below the EU average of 11%, yet produces excellent results, demonstrating high system efficiency and value for money. Public funding covers 71.6% of health expenditures, limiting direct out-of-pocket costs and protecting households from catastrophic health spending.
Compared to the United States, where life expectancy is lower (about 78.5 years) and out-of-pocket costs and insurance complexities are much higher, Spain’s system provides much broader, more equitable access without significant financial barriers. Unlike the fragmented US model, Spain’s unified public system, supported by a complementary private sector (opted by about 28% of residents), ensures timely access and strong preventive care.
This integrated approach, balancing universal coverage with innovation and patient-centered care, results in better population health, lower avoidable mortality, and high patient satisfaction, establishing Spain as a global benchmark for efficient, accessible healthcare compared to other European countries and the US.
In summary. In Spain:
