Madrid and Balearics Lead Spanish Healthcare Privatisation as Private Insurance Jumps 81% Since 2014

Regional privatisation index rankings

The Federation of Associations for the Defence of Public Healthcare (FADSP) presented its 12th annual report on Tuesday, tracking the degree of healthcare privatisation across Spain's autonomous communities. The Community of Madrid recorded the highest privatisation index at 34 points out of a possible 40, rising 6 points compared to the previous year. The Balearic Islands and Catalonia followed in second place with 28 points each, while the Canary Islands scored 26 points, the Basque Country scored 24 points, and Asturias scored 23.5 points. At the lowest end of the scale, La Rioja scored 12 points, Murcia 15.5 points, Extremadura 17.5 points, and Castilla y León 18 points, compared to a nationwide average of 21.8 points. Privatisation scores rose over the past year in nine regions: Madrid, the Basque Country, Asturias, Cantabria, Galicia, Catalonia, Navarra, Castilla-La Mancha, and Castilla y León.

Expansion of private insurance and household spending

Private healthcare adoption across Spain is driven by mounting delays in primary and specialist care appointments. The report found that 14.2 million citizens held private healthcare insurance in 2025 (accounting for 21% of Spain's population in 2026), representing an 81% increase since the initial 2014 study. Out-of-pocket household healthcare expenditure grew by 52.8% over the same period, reaching a national per capita average of 566.40 euros annually. In 2025, total private health expenditure in Spain reached approximately 34 billion euros, which accounts for 2.5% of gross domestic product and 27% of all healthcare spending in the country. FADSP secretary Sergio Fernández explained that mounting wait times force citizens with financial means to seek private alternatives.

More and more people are paying out of their own pockets to get care that they cannot find in time in the public healthcare system. Getting an appointment in primary care is becoming very difficult, a specialist consultation takes months, and whoever has the resources and can afford it looks for an exit in the private sector. Those who cannot must wait.

Contracting disparities and regional trajectories

Public resource transfers to private providers through outsourced contracts (conciertos sanitarios) vary significantly across autonomous communities. The national average of public healthcare budgets dedicated to private contracts is 6.29%. Catalonia allocated the highest proportion at 21.6%, while Madrid dedicated 12.0%. By contrast, Castilla y León allocated 3.7%, Cantabria 3.5%, and La Rioja 2.4%. Private hospital beds also reflect this divergence, comprising 54% of total bed capacity in Catalonia compared to 21% in Castilla y León. In addition, per capita spending on private insurance reached 381 euros per year in Madrid, compared to 227 euros in Castilla y León and a national average of 210 euros.

Since 2014, privatisation has expanded in every autonomous community except Murcia and La Rioja. Asturias experienced the fastest relative growth, rising 95.8%, followed by Extremadura at 94.4%, Castilla-La Mancha at 90%, and Andalusia at 70%, though Andalusia reduced its score over the past year due to budgetary reallocations. Report coordinator José Manuel Aranda noted that public healthcare deteriorations encourage reliance on private agreements.

The social and political justification for privatisation is the assumption that public healthcare services are insufficient to satisfy the demand of the population.