Healthcare is no longer what it used to be. Or yes, depending on who analyzes it. For Pedro Sánchez, the health of our public health "is the thermometer of the democratic health of a country." This was how blunt and proud he was in the month of April during the institutional event commemorating the 40 years of validity of the General Health Law, where he recalled that, since the arrival of his Executive, health spending has increased by 30% and "300,000 million euros more than what the previous Administration did," the President of the Government stressed.
However, Spain has a problem of mistrust in the "jewel in the crown." And this is how its citizens express it through the latest data from the CIS Health Barometer that detects the population's discomfort, since satisfaction with the National Health System is at a minimum: 6.19 out of 10, half a point less than in 2018 when the PSOE came to power. Added to this is that the latest Spanish Health Survey 2025 (ESdE 2025) reveals that the positive perception of the health of Spaniards drops to the lowest level in the series. Only 68.3% consider their condition to be good, the lowest percentage since 1987.
In Health, "you can see only the tip of the iceberg of what is working poorly: the waiting lists, but there is more underneath," said Nuria Mas, an economist specialized in the health sector during her speech at the ConCiencia event held this week.
There are key challenges that, if not addressed, can break the tight seams of a healthcare system that lives off the wickerwork designed for a 40-year-old society. "Size, geography and population aging impact the productivity and sustainability of the welfare state in Europe and Spain," said Mas, also a member of the Board of Directors of IESE Business School.
A system that must turn to chronicity
Spain, with healthcare transferred to its communities, faces providing healthcare to more than 49 million people, with 20% of the population over 65 years of age and with the projection that in two decades this age group will be practically a third. Furthermore, chronic diseases affect more than half of the population over 15 years of age; approximately 66.2%, according to the latest ESdE 2025 data from the INE.
This translates into a bill that accounts for 80% of Primary Care consultations and greater spending on medicines. The latest data published by Health (2024) indicate that pharmaceutical spending charged to the SNS through medical prescriptions amounted to 13,865 million euros, 650 million more than in 2023. The pharmaceutical bill in 2024 thus grew by 4.9% compared to the previous year.
Linked to drugs is the problem of access to them. There has been improvement over the past two years, but there is still work to be done. The WAIT Report, carried out by the European association of the pharmaceutical industry (Efpia), reveals that, although the waiting time dropped to 537 days (compared to 616 the previous year), our country triples the European legal limit and finances new medicines with a high level of restrictions.
From macro to regional budgets
From the Gaspar Casal Foundation (FGC), a group of health economists has prepared the Evaluation Report of the National Health System (SNS), presented last June, which offers solid quantitative and qualitative data that points to the current paradox: record spending compared to the drop in actual execution.
Although at a macroeconomic level there is talk of historical investment ceilings, the money does not reach the services and the patient's bedside with the same agility. Total health spending in Spain exceeds 130 billion euros, where the public sector represents more than 74% of total billing, according to the FGC. This same document states that public spending on health in Spain stands at 6.8% of GDP (2022 data), a percentage clearly lower than that of our surrounding countries: Germany allocates 10.58%, France 9.74% and the United Kingdom 9.05%.
A hospital-centric system
It should also be noted that our healthcare model suffers from a strong "hospital-centric" bias that stifles the first level of care. And this leads to an unequal distribution of spending: of the total consolidated public health spending, hospital services systematically absorb between 62% and 63% of the resources. On the contrary, primary care remains almost frozen and underfunded, chronically receiving only between 13% and 14% of the global budget. And despite the investment plans in the first level of care with a disbursement of 172 million, the budgets of the CCAA are still far from reaching the 25% requested by primary school professionals.
In the hospital field there are contrasts in the evaluation: admission receives a 7.02 and 061/112 a 7.26 are the best rated services, but the worst is in the consultations: 5.74 out of 10. Here the waiting lists have a lot to do with it: 4,072,139 people were waiting for an appointment with the specialist in December, an average of more than 102 days. On this issue, 45.1% of the population thinks that everything remains the same and 38.2% thinks that it has gotten worse. The average times for diagnostic tests range from 60.49 days for a CT scan, 64.71 days in the case of ultrasounds and 72.94 days for an MRI. Colonoscopies are at a greater distance with 125.31 days on average.
Technological obsolescence
A third of the national hospital technology park is still more than 10 years old, a figure that triples what is recommended by international standards, which establish a maximum limit of 10% for equipment of that age. Pablo Crespo, general secretary of the Spanish Federation of Health Technology Companies (Fenin) recently defended in this medium the development of "a planned and sustained investment strategy in the medium and long term that allows the incorporation and continuous renewal of the set of health technologies", so as not to have to "live on shock plans."
Despite this, Crespo does not detract from the 796.1 million euros that European funds, under the heading of the Investment Plan for High Technology Equipment (INVEAT), were allocated to renew up to 868 high technology equipment. Linear accelerators, magnetic resonance imaging, digital brachytherapy equipment, planning and conventional CT, vascular and neuroradiology angiographies, SPECT-CT, PET-CT gamma cameras and hemodynamics rooms were installed that replaced those that were more than a decade old and that made it possible to reduce the obsolescence of the national technology park by about 10 percentage points, between 2021 and 2022.
Before the arrival of European funds, in 2015 the Amancio Ortega Foundation donated the equivalent of 38% of the amounts of the INVEAT Plan (Investment in High Technology Equipment): 300 million euros that allowed the installation of more than 450 state-of-the-art equipment with the maximum features available on the market. Focused on providing service to the Oncology area, there were ones for diagnosis (mainly mammograms, ultrasounds, CT scans and MRIs) and treatment (mostly linear accelerators to apply radiotherapy).
SNS update plans return to square one
To correct many of these problems that deteriorate different aspects of healthcare provision, the following have been left unprocessed with the dissolution of the Cortes: the Framework Statute (updates the working conditions designed in 2003), the Medicines Law (whose last update was in 2015), the Digital Health Law, the Equity and Cohesion Law and the Anti-Tobacco Law (which has not been reformulated and adapted to new devices since 2010). The new accounting of waiting lists was also left in the drawer, since the CCAA rejected the project of Mónica García's ministry.
