MADRID, February 14, 2026
Spain Moves to Prioritize Public Healthcare, Curb Privatization
A new draft law aims to reinforce the universal and equitable nature of Spain’s National Health System.
- Spain’s Council of Ministers approved a draft law prioritizing public management within the National Health System (SNS).
- The legislation seeks to limit private sector involvement, citing fragmentation and transparency concerns.
- International studies, including an analysis of 38 OECD countries, informed the draft, suggesting public systems utilize resources more efficiently.
- The law also streamlines financing for health products and strengthens the role of patient organizations.
Spain is doubling down on public healthcare. The Council of Ministers recently approved a Draft Law on Public Management and Integrity of the National Health System (SNS) designed to ensure public entities take the lead in organizing, providing, and administering health services. The move comes as officials aim to address what they see as creeping privatization that has eroded transparency and institutional control.
The Case for Public Control
Since its inception, the SNS has largely operated under public management. However, “the proliferation of private models in recent decades has led to fragmentation, transparency deficits and less capacity for institutional control,” according to a statement from the Ministry of Health. The draft law is built on international research, including a review of 38 OECD countries, which found no evidence that privatization boosts efficiency. In fact, the analysis indicated public systems generally make better use of resources.
Specifically within Spain, evidence suggests indirect management models have yielded worse outcomes. Analysis shows these models resulted in more avoidable hospitalizations and higher mortality rates from heart attack or stroke compared to similar public hospitals. Privatization, the data also indicates, is often linked to workforce reductions, potentially compromising care quality and long-term sustainability.
Defining Public and Indirect Management
The draft law clearly defines “direct management” as provision by the health administration itself, through state entities, or via health consortia formed between public administrations. Indirect management, however, will be limited to exceptional circumstances where direct provision isn’t feasible, financial sustainability and efficiency are guaranteed, and quality, continuity, accessibility, and affordability are maintained.
Any instance of indirect management will require a rigorous evaluation process, including a justifying report, analysis by an expert committee with representation from various stakeholders, public publication of findings, and, in the case of service concessions, a financial sustainability report from the National Evaluation Office (ONE). The law also eliminates mixed contractual formulas that previously linked infrastructure development with service provision.
Industry Pushback and Patient Rights
Not everyone is on board. The Institute for the Development and Integration of Health (IDIS Foundation) argues that limiting private sector management could hinder efforts to reduce waiting lists and improve efficiency. IDIS maintains that public-private collaboration is crucial for accessibility and quality of care.
However, the Council of Ministers also approved a Draft Bill on Patient Organizations, a move lauded by advocates. This legislation, the first of its kind, formally recognizes the role of patient organizations within the SNS, solidifying their position as key defenders of patient rights and interests. Currently, these groups operate under general association laws, lacking specific recognition within the healthcare system.
Modernizing Health Product Financing
Finally, a Royal Decree was approved to modernize the financing of health products for non-hospitalized patients. The new regulations replace rules dating back to 1996, aiming to prioritize efficiency, sustainability, and clinical value. The decree establishes a selective financing system with transparent criteria for inclusion, modification, and exclusion of products, and is intended to foster innovation and industrial development within the sector.
The changes are expected to unlock access to new suppliers and products, promoting competition and improving patient access to cutting-edge healthcare technologies. The Interministerial Commission on Medicines Prices will continue to oversee pricing for these items.
Worth a look
