Digital Health in Spain
Key Figures
47M
residents
17
autonomous communities (CCAA)
9.1% of GDP
for the 2019 health care budget
A decentralized healthcare system centered on the CCAA
The 17 autonomous communities have the authority to establish standards within the framework set by national health care regulations. They decide on funding to supplement that provided by the central government, local public health policies, the organization of the regional health system, accreditation and planning of the system, as well as the procurement and provision of services. The central government and the regions coordinate their activities through an interterritorial council that brings together the Minister of Health and the health ministers of all the autonomous communities to jointly decide on common strategies and guidelines.
The Spanish public health system follows the model of a national health system, fully funded by taxes and providing universal health coverage for the population. Of total health expenditures, 73.51% are public expenditures and 26.48% are private health expenditures.
The Spanish government has increased funding for digital health initiatives
- In 2020, the Ministry of Health established a General Secretariat for e-Health, Information, and Innovation
- In December 2021, the government adopted a national digital health strategy. It calls for public-private cooperation to carry out initiatives of particular interest to the national health system
At the same time, the Autonomous Communities (CCAA) are also driving public policies and initiatives related to health innovation at the local level. Catalonia and the Barcelona metropolitan area are the most dynamic regions in terms of digital health.
How can I enter the Spanish market?
1. The eight health technology assessment agencies responsible for evaluating new health technologies.
These evaluations are shared within the network of these agencies, known as RedETS. These agencies are:
- AETS – ISCIII at the national level,
- UETS – ALE for the Madrid Region,
- AETSA in Andalusia,
- AVALIA-T in Galicia,
- AQuAS/AATRM in Catalonia,
- SESC for the Canary Islands,
- OTESBA in the Basque Country
- IACS in Aragon.
2. The governments of the 17 autonomous communities
The CCAA manage their own health budgets and issue requests for proposals for their healthcare centers. They can base their decisions on certifications from health technology assessment agencies. The IT and/or innovation departments serve as the points of contact.
In addition, the CCAA often have their own healthcare innovation hubs. These hubs bring together local ecosystems and provide facilities for innovation initiatives.
3. Hospital Supply
Hospitals procure their own medical devices. They have a budget—in which public subsidies play a predominant role—that allows them to choose their own devices. They represent a third entry point into the Spanish market for bringing a medical device or digital health product to market. More than half of Spain’s hospitals are private. This system is supplied independently of the public system.
4. Spain Up Nation
Spain has developed a strategy for an entrepreneurial nation to create a new economic and social model, based on three interconnected pillars: innovative entrepreneurship, the sectors driving the Spanish economy, and the reduction of social disparities.
This program is being developed in partnership with ENISA, which provides funding for innovative companies and operates its digital enterprises division; RED.ES, which promotes Spain’s digital agenda—particularly in the areas of health and social services; and ICEX, which supports the internationalization of businesses.
5. The General Secretariat for e-Health, Information, and Innovation in the National Health System
The General Secretariat for Digital Health, Information, and Innovation of the National Health System is responsible for overseeing projects related to the modernization, innovation, improvement, and transformation of the national health system, particularly those related to digital health and information systems. Together with the autonomous communities, it coordinates the implementation and oversight of the digital health strategy for the National Health System (SNS) through the Digital Health Commission.
Government agencies and platforms
Ensuring the smooth operation and cooperation within the healthcare system
Support and Innovation Initiatives
They bring together and facilitate the incubation of new technologies
Training
Universities and their groups that foster and support digital innovations in healthcare
The Spanish healthcare system is based on a nationally funded, tax-supported model that guarantees healthcare coverage for the entire population. Structured around 17 autonomous communities, it entrusts each region with the management of its own health services, from the organization of primary care centers to the procurement of medical devices. This decentralized approach sharply distinguishes Spain from France, where the social security system is based on a more centralized structure managed from Paris.
Public spending accounts for nearly 74% of the total health budget in Spain, with the remainder coming from private spending. French nationals living in Spain, like all expatriates, can rely on coverage under the national system, provided they meet the eligibility criteria for enrollment in the Spanish social security system. For those who do not have sufficient coverage, taking out international health insurance or private health insurance is still recommended in order to access the full range of available medical services.
The primary care physician plays a central role in the Spanish healthcare system: referrals to specialists and hospitals are made through them. Primary care centers are the first point of access to care, and their regional coverage varies from one autonomous community to another. Madrid, Barcelona, and other major cities have facilities recognized for their quality at the European level.
Public coverage includes doctor’s visits, inpatient hospital care, and a portion of prescription drugs. However, dental care is primarily provided by the private sector, prompting many residents—whether Spanish or expatriates—to purchase specific supplemental insurance. Medical devices, meanwhile, are subject to rigorous evaluations by regional agencies coordinated at the national level.
The Spanish Agency for Medicines and Health Products (AEMPS) manages and oversees the marketing of medicines and health products throughout the country. Its role is comparable to that of the ANSM in France, ensuring consistent quality standards for both patients and healthcare professionals.
For an expatriate looking to settle in Spain, understanding the relationship between the national public system and private options is essential. There are numerous health insurance options available on the Spanish market, tailored to a variety of profiles, from families to self-employed individuals. Comparing the system to the French social security system often highlights differences in coverage, particularly regarding medications, specialized care, and hospital costs.