Health: waiting lists and spending by region
More than 850,000 people are waiting for surgery in the public health system, and how long they wait depends heavily on where they live. Spain spends less on public health care than the EU average, and households pay a larger share out of their own pockets. Spending more per inhabitant does not guarantee shorter waits either: across regions, the two are barely related.
Spain and Europe
Spain spends less on public health care than the European average, and a larger share of the bill is paid directly by households.
Health care is run by the regions, but central government sets the common rules: which services the public system covers, the guaranteed maximum waiting times and the funding system for the regions. All three depend on national laws and decrees that the Government and parliament that emerge from the 29 November election will be able to change. In 2024, public spending on health was equivalent to 6.5% of GDP, below the EU average and in the middle of the table: Austria, Czechia, Croatia or France devote between 8.9% and 9.5%. The gap also shows per inhabitant, adding public and private spending: measured in purchasing power standards (a unit that corrects for price differences between countries), Spain spent 3,319 per person, 19% less than the EU average (4,075).
Spain spends 6.5% of its GDP on public health care; the EU, 7.3%
Public spending on health, 2024, as % of GDP. Spain ranks 15th of 27 countries
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What the public sector does not pay is mostly paid by households. In Spain, government and social security cover 72.2% of health spending, eight points less than in the EU as a whole (80.3%). Voluntary insurance pays 6.3%, and households 21.5%, directly out of their own pockets. That direct payment includes their share of the price of prescription medicines, but also services the public system barely covers, such as the dentist or glasses, and private consultations.
Households pay 21.5% of health spending out of pocket in Spain; in the EU, 15.1%
Household out-of-pocket payments, 2024, as % of current health expenditure. Spain ranks 11th of 27
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Spain from within
The wait for surgery ranges from under two months to almost six depending on the region, and it does not follow spending per inhabitant.
On 31 December 2025, 853,740 patients were waiting for non-urgent surgery in the public health system, and they had been on the list for 122 days on average. The differences between regions are large. In Andalusia and Catalonia, one in three patients (32.2% and 32.0%) had been waiting for more than six months; in Madrid, fewer than one in a hundred (0.8%), and in the Basque Country 2.3%. The wait for a first appointment with a specialist follows a different order: the average is 102 days, ranging from 32 in La Rioja to 162 in the Canary Islands, leaving aside Ceuta and Melilla. Madrid, which has the shortest surgical wait, is the region with the most patients per inhabitant waiting for that first appointment (134.7 per 1,000).
Patients waiting for surgery in Andalusia have waited 173 days on average; in Madrid, 50
Average time waited by patients pending surgery, 31 December 2025, in days. Spain: 122 days
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Nor do they spend the same. In 2024, the Basque Country and Asturias spent more than 2,300 euros per inhabitant on health; Andalusia, the lowest, and Madrid, the second lowest, less than 1,800. But spending more does not translate into waiting less: across the 17 regions, the relationship between spending per inhabitant and the surgical waiting time is practically zero (correlation coefficient of -0.09). Madrid spends little and has the shortest wait; Andalusia spends the least and has the longest; Cantabria and Extremadura spend more than 2,200 euros and their patients have been waiting more than 130 days. Waits also depend on how many patients join the list, on how operating theatres and specialists are organised, and on how each region counts its own list.
Regions spend between 1,658 euros per inhabitant on health (Andalusia) and 2,332 (Basque Country)
Public health spending by each region, 2024, in euros per inhabitant. All regions: 1,958 euros
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Policy file: guaranteed maximum waiting times
- What it is. Royal Decree 1039/2011 guarantees every National Health System user a maximum of 180 calendar days, from the moment the doctor prescribes the operation, for five procedures: heart valve surgery, coronary heart surgery, cataracts, hip replacement and knee replacement.
- Who and when. The Government approved it in July 2011, under Law 16/2003 on the cohesion and quality of the National Health System, and it has been in force since 30 August 2011. The regions set out the guarantee in their own territory and can establish shorter deadlines.
- What should happen. No patient should wait more than 180 days for those operations. If the deadline cannot be met, the health service must offer alternatives, such as surgery at another hospital. Patients who turn down the alternative lose the guarantee.
- What we compare it with. With the percentage of patients waiting for those operations who had been on the list for more than six months on 31 December 2025, according to the Ministry of Health report.
The result. Six months are roughly equivalent to the guaranteed 180 days. At the end of 2025, 15.9% of patients waiting for a knee replacement and 13.7% of those waiting for a hip replacement had been on the list for more than six months. For heart valve surgery the figure was 6.9%; for cataracts, 2.6%, and for coronary surgery, 1.6%. These are figures for the whole system: the report does not break them down by region. And they measure the structural list, which patients who turn down surgery at another hospital leave, so they do not say how many patients lost the guarantee.
Spain over time
More patients are waiting than before the pandemic, and money has become increasingly concentrated in hospitals.
The pandemic sent waits soaring: in June 2020, patients had been on the list for 170 days on average, against 121 at the end of 2019. The average time has returned to that level (122 days at the end of 2025), but the list is longer. The peak was at the end of 2023, with 18.1 patients per 1,000 inhabitants. More patients join than before, 2.81 million in 2025 against 2.47 million in 2019, but per inhabitant almost the same number (58.2 per 1,000 against 57.2). The list per inhabitant, by contrast, is 14% longer than at the end of 2019.
For every 1,000 inhabitants, 17.7 people are waiting for surgery; at the end of 2018, 14.8
Patients on the surgical waiting list per 1,000 inhabitants, on 31 December each year, 2018-2025
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In 2024, public health spending by all levels of government came to 101,739 million euros, and it is increasingly concentrated in hospitals and specialists. The prescription bill has grown much less and lost weight. Part of the change is an accounting one: medicines dispensed in hospital do not count as pharmacy but as hospital spending, and this data does not allow them to be separated. Primary care, the entry point to the system, keeps almost the same share as in 2002, around one in every seven euros.
Hospitals take 62% of public health spending, against 53% in 2002; pharmacy falls from 22% to 14%
Breakdown of public health spending by function, 2002-2024, as % of the total
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What this data does not say. The waiting list measures how long those still on it have waited, not how long the others took to be operated on, and it leaves out those waiting by their own choice or for clinical reasons. Each region counts its own list and is responsible for its data, according to the Ministry itself, which compiles them; in the past there have been changes in counting methods that break the series, such as Andalusia's in 2018. Spending per inhabitant does not take into account the age of the population or what the civil servants' mutual funds pay in each territory. The European comparison mixes systems with different packages of services: household payments are higher where the public system covers less, such as dental care. And neither waits nor spending say anything about the quality of care or its health outcomes, nor do they allow the differences to be attributed to the management of a particular government.
See also: Regional finance: who raises the money, who receives it and whom the regions owe
Sources for the text
- Real Decreto 1039/2011, de 15 de julio, por el que se establecen los criterios marco para garantizar un tiempo máximo de acceso a las prestaciones sanitarias del Sistema Nacional de Salud
- Real Decreto 605/2003, de 23 de mayo, por el que se establecen medidas para el tratamiento homogéneo de la información sobre las listas de espera en el Sistema Nacional de Salud
- Ministry of Health, SISLE-SNS: summary indicators on 31 December 2025 (corrected version), including guaranteed procedures and outpatient appointments
- Eurostat, health spending per inhabitant in purchasing power standards (hlth_sha11_hf)
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