The weight of private healthcare in the surgical activity of the National Health System
The health system in Spain is a mixed system in which public health, managed by the National Health System (SNS), and private health, made up of non-public hospitals and clinics, coexist.
“In recent years, the private sector’s participation in the NHS’s surgical activity has increased considerably, generating a necessary debate on its implications in terms of efficiency, accessibility and equity in healthcare.“
The context of mixed healthcare in Spain
The National Health System (SNS) is responsible for the provision of most healthcare in Spain, financed through taxes and offering universal coverage to the population.
However, private healthcare plays a decisive role, not only as an alternative for those seeking faster or more specialized care, but also as a complement to the public system through agreements and outsourcing of services.
“Spain has 751 hospitals, of which 449 (approximately 60%) belong to the NHS. These institutions offer a total of 155,077 beds, distributed as follows: 82.5% (126,004) for the public network and 17.5% (29,073) for the private sector.“
The ratio of beds per 1,000 inhabitants has decreased slightly, from 3.30 in 2013 to 3.24 in 2022. This decrease is partly due to the increasing number of procedures being carried out on an outpatient basis, which has risen from 41.72% to 48.30% in the same period.
Health agreements between the SNS and the private sector allow patients to be referred to private centers with the aim of reducing waiting lists and optimizing resources.
In the surgical field, these agreements have intensified in autonomous communities with greater healthcare pressure, especially in high-demand procedures such as traumatology, ophthalmology, and general surgery.
Surgical activity and public-private collaboration
In 2022, there were 5.2 million hospital admissions in Spain.
The SNS attended to 4.1 million of these admissions, with an average stay of 7.8 days, and performed 3.5 million surgical interventions, of which 49% were outpatient surgery.
“Private hospitals carried out 1.7 million surgeries, 38% of them on an outpatient basis. It is worth noting that 25% of these interventions in the private sector were financed by the public system, although this percentage has decreased by three points since 2013.“
The increase in the referral of surgeries to private healthcare is driven by several factors, including:
- Long waiting lists in the public health system
The high demand for surgical procedures has generated waiting times that in some cases exceed six months. - Lack of resources in public hospitals, such as a shortage of operating theatres, health personnel and medical supplies.
- Health management strategies
Some autonomous communities have adopted active policies of collaboration with the private sector to alleviate the burden on the SNS.
Human resources in the SNS and private healthcare
Staffing levels are a crucial factor in the provision of quality healthcare services.
There are 585,253 professionals working in SNS hospitals and associated centres, of which 98.2% are permanent staff.
In contrast, private hospitals have 74,597 professionals of their own and 34,379 who provide services through non-salaried links.
The ratio of doctors per 100 beds is 81.3 in the SNS and 33.3 in the private sector, showing a higher density of professionals in the public sector.
“The ratio of doctors per 100 beds is 81.3 in the SNS and 33.3 in the private sector, showing a higher density of professionals in the public sector.“
Hospital financing and expenditure
Total hospital expenditure in 2022 reached 60.5 billion euros, with 53.6 billion corresponding to public hospitals and 6.9 billion to private hospitals.
In public hospitals, the largest item is personnel expenses (47.3%), followed by purchases and current expenses (36%), of which almost half corresponds to pharmaceutical products.
In the private sector, the main expenditure is concentrated on purchases (43%), with 17% going to pharmaceutical products.
Advantages and disadvantages of private participation in the NHS surgical activity
Advantages
- Reduction of waiting lists
Referring patients to private hospitals allows more interventions to be carried out in less time, reducing waiting times for patients. - Optimization of resources
By taking advantage of the infrastructure and personnel of the private health sector, the public system can concentrate on more complex cases and emergency care. - Flexibility and efficiency
private centers, in many cases, have a greater capacity to manage operating theatres and operating hours without the bureaucratic limitations of the NHS.
Disadvantages
- Impact on the equity of the system
Dependence on private healthcare generates inequalities, since those who can afford private insurance or direct private care can access surgery more quickly than those who depend exclusively on the NHS. - Additional costs for the public system
Although healthcare agreements can reduce waiting lists, they also imply additional expenses for the NHS, given that interventions in private centers tend to have a higher cost than those in public hospitals. - Risk of disinvestment in the public sector
If the public health system resorts excessively to the private sector, investment in public hospitals could be reduced and affect the quality of service.
Una colaboración necesaria
La interacción entre el SNS y la sanidad privada en España es clave para garantizar una atención sanitaria eficiente y accesible. .
La colaboración en la actividad quirúrgica ha permitido abordar desafíos como las listas de espera y la optimización de recursos.
Sin embargo, hay que mantener un equilibrio que asegure la equidad en el acceso y la sostenibilidad del sistema sanitario en su conjunto.