Nearly 13 Million People in Spain Now Have Private Health Insurance — and Public Pressure Is Why

12.8 Million People — and Rising

Nearly 12.8 million people in Spain now hold private health insurance, up from around 11 million in 2020. Private coverage has grown from 23% of the population in 2020 to 26% in 2025, with more than 200,000 new policies taken out in the past 12 months alone.

The private sector now handles 30–40% of all medical activity in Spain, carries out more than 42% of all surgical procedures, and covers nearly one third of all emergency cases.

Why People Are Leaving the Public System

The primary driver is waiting times. Patients who need to be seen quickly — for specialist appointments, diagnostics, or elective procedures — are increasingly turning to private providers rather than waiting months in the public system.

Sergio Fernández, spokesperson for the Federation of Associations for the Defence of Public Healthcare, is critical of the trend: "Those wanting faster care end up paying twice — through their taxes and through their insurance policy."

Guillén del Barrio, an emergency nurse at Madrid's La Paz Hospital, put it more bluntly: "The system is pushing them out." Overcrowding and staff shortages are leaving patients with little choice but to go private for routine care.

Where Private Cover Is Highest

The regions with the highest rates of private health insurance — all above the national average of 26% — are:

• Madrid
• Catalonia
• Balearic Islands

The Private Sector's Defence

Marta Villanueva, CEO of the IDIS Foundation (Institute for the Development and Integration of Healthcare), argues the opposite: that private providers are helping the public system by absorbing millions of routine consultations each year, reducing pressure on public hospitals.

A Structural Problem

Critics point to a fundamental flaw in the two-tier arrangement: patients with private insurance still rely on public hospitals for serious illnesses, complex surgery, and high-cost emergencies. This means private providers profit from routine, lower-risk treatments — while the public system absorbs the burden of the most expensive and complex cases.

Staff shortages, growing patient demand, and chronic underfunding are all cited as contributing factors. The growth of private coverage is increasingly seen not as a sign of a thriving healthcare market, but as a signal that Spain's public system is struggling to meet its obligations.

This article is based on reporting from Spanish News Today, published May 2026.