Health insurers suffocate private doctors in Spain

by Lorraine Williamson
private doctors

The Spanish Society of Oral and Maxillofacial Surgery and Head and Neck Medicine (SECOMCyC) warns of the situation of suffocation of private doctors. This is because health insurers have been paying the same reimbursement for 30 years.

The responsibility that the medics take on is not commensurate with their compensation, according to SECOMCyC. 

Private doctors cannot negotiate reimbursement on their own 

Dr. María Teresa Martínez Iturriaga, a specialist in oral and maxillofacial surgery and head of department at the San Rafael Hospital in Madrid, emphasises that private doctors cannot negotiate their own fees. 

“We are bound by the rates of the insurance companies, because they control 90% of the market for private medicine.”  This fact was denounced by the European Court of Competition. “The Court ruled in our favour and said that doctors in Spain could unite to negotiate our rates. 

Collective bargaining 

The National Commission for Markets and Competition (CNMC) reported that the private sector medics can collectively negotiate with insurance companies and hospitals about their salary conditions. 

Unfortunately, they “refuse to bargain collectively with independent doctors at the moment,” according to Martínez Iturriaga. ‘This is special, because the turnover of both insurance companies and private hospital groups is growing exponentially every year’. 

Medical reimbursements have therefore not yet been increased. However, the service portfolios have been expanded. “The responsibility we take on is not proportional to what we are paid. Consequently, the only way we can survive is by volume,” concludes Martínez Iturriaga. 

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Short consultation with private doctors 

This whole situation makes patients wonder a consultation is so short. ‘It has everything to do with the fee of €8 for the consultation. And if we see them the following week because they have a problem and we need to check them regularly, the insurance won’t pay us for the new consultation. My medical ethics tell me to check them the week after, but I’m not going to charge for it,” says Dr. Martínez Iturriaga. 

Claiming rights jointly 

To stand up for their rights, doctors from different medical specialties have united in the Unipromel platform that is responsible for claiming their rights. “At the moment, the companies still don’t want to give in. However, we have the support of the Madrid College of Physicians. This has set up a committee for free practices to fight against this problem. What we want is to spread the message,” says Dr. Martínez Iturriaga. 

The platform was founded in Seville three years ago. It now works at both national and European level. Unipromel’s first action was to contact the European Competition Court and the CNMC. The latter has already made a recommendation. This allows private doctors to collectively negotiate their fees and collectively demand new rates. 


In addition, 14 scientific societies signed the so-called ‘Manifiesto Dignifica’ (including the SECOMCyC), a manifesto originating from the Spanish Society of Neurosurgery. It states that due to the circumstances, doctors are unable to provide the quality of medical care that patients need. A situation that is at odds with medical ethics. 

Training of 13 years should be rewarded 

Dr. María Teresa Martínez Iturriaga points out that not everyone is able to complete the 13 years of training from the time they start their medical studies to the time they enter the job market. That requires a lot of dedication, working a lot of shifts, often giving up sleep, having a lot of courage to stand in front of a patient in an operating room with a scalpel in your hand… There has to be a reward in return’. 

If nothing changes, there will be no qualified professionals left in Spain, doctors and healthcare workers will leave for abroad. 

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