MADRID – The privatisation of health services is on the rise all over Spain. The Autonomous Communities of Madrid and Catalonia are at the forefront of these developments. Furthermore, they are the areas with the highest private health expenditure per capita and year.
Most of the money there also goes to the recruitment of private centres. This is evident from the ninth report of the Federation of Associations for the Defense of Public Health (FADSP) on the privatisation of health care in Autonomous Communities. The association denounces the “privatising trend” of the Spanish health system. Spending on agreements with private centres has increased by almost 9% nationwide, according to the latest data used from 2021 and 2022.
Highest level of privatisation in Madrid
The report considers Madrid to be the autonomous community with the highest level of privatisation of its health services in all of Spain. It has a score of 32 points on a scale where the maximum is 33. Madrid is then followed by Catalonia (29), the Balearic Islands (27) and the Canary Islands (24).
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A resident of Madrid spends €919.73 annually on private insurance and health costs “out of pocket”, such as consultations with specialists, unfunded medicines and co-payments. Meanwhile, in the case of a Catalan citizen, the expenditure is €808.13.
The privatisation process tightened up during pandemic
Presenting the report, FADSP spokesperson Marciano Sánchez Bayle explained that the privatisation process has tightened during the pandemic. Also, it has been furthered by budget cuts and the deterioration of public health.
“I think there is a deliberate policy of deteriorating public health so that people who can afford it turn to the private sector,” said Marciano Sánchez in an interview on RNE. He explains that the number of people with insurance has increased from 9.6 million in 2010 to 11.6 million today. In addition, the referral of funds to the private sector has increased. He also referred to the Community of Madrid, where this privatisation process has increased since the transfer of powers and, in his view, has intensified under the government of Isabel Díaz Ayuso.
Highest expenditure on private contracts in Catalonia
The report reveals that Catalonia is the autonomous community that spends the highest percentage of health expenditure on contracting private centres at 23.9%, followed by the Community of Madrid at 11.7%.
The Balearic Islands follow these autonomous regions with an allocation of 8.6% of its health budget to private contracts; the Canary Islands with 7.3%; and the Basque Country with 6.7%, all above the national average (6.6%).
Castilla y León is the autonomous region that spends the least health budget on hiring private centres, at 2.8%. This is followed by Aragon, with 3.7%, and Andalucia with 3.9%. According to the report, “An increase in public funding of the private sector leads to an increase in preventable deaths. This is because it is accompanied by a parallel underfunding of public management centres.”
Privatisation is on the rise in all autonomous regions
The report finds that privatisation is on the rise in all autonomous regions, although the intensity varies more or less depending on the territory. Cantabria is the Spanish community with the least amount of privatisation. Here, it has 13 points out of the maximum possible 33. This result puts it 19 points below the difference with the Autonomous Community of Madrid. According to the FADSP, these “excessive differences” represent a lack of coherence in the National Health System.
Cantabria repeats itself as the community with the lowest degree of privatisation in health, as does Extremadura, with 14 points, and Castilla-La Mancha, with 15.
With an average degree of privatisation, in order from lowest to highest is as follows;
- the Basque Country
- Murcia
- La Rioja
- Castilla y León
- Asturias
- Aragon
- Valencian Community
- Galicia
- Andalucia
- Navarra
Private health expenditure is 26.7% of the total
According to the report, private health expenditure in Spain amounts to 26.7% of total health expenditure, three points higher than the Organisation for Economic Co-operation and Development (OECD) average, which is set at 23.7%. At the same time, out-of-pocket expenses for non-reimbursable drugs, specialists and part of the prescription costs amount to 19.6%, one and a half points more.
More inequality and exclusion
According to the FADSP report, this increase in private insurance naturally leads to increased inequality and exclusion because only people with more resources can access it. Part of private health expenditure is spent on paying for insurance. Madrilenians spend €337 per person per year on this, followed by the Balearic Islands (€293), Catalonia (€270) and the Basques with €196 per year per inhabitant.
In terms of so-called “pocket money” for costs not covered by public health care, La Rioja tops the list with €659.95, followed by Madrid (€582.73), Catalonia (€538.13) and Navarra (€526.49).
Distribution of private hospital beds
Another aspect that the FADSP examines is the distribution of private hospital beds and the percentage of advanced technology in private hospitals. In Spain, 26.73% of hospital beds are in private centres. Catalonia takes the lead with 54.5%, followed by Navarra with 40.57%. In third place are the Balearic Islands (36.71%), ahead of the Canary Islands (34.23%) and the Madrid region with 32.21%.
On the other side are Castilla-La Mancha, with only 6.16% of private beds, and Extremadura, with 9.51%. In terms of advanced technology, 34.41% of the equipment is located in private centres with Balearic Islands taking the lead with 52.85%, followed by Navarre with 51.61%.
The report also contains data on consultations with GPs in the private sector. Residents of the Balearic Islands make the most use of this at 27.2%, followed by Catalans (24.3%) and Madrilenians (23%).
