The volume of health premiums in Spain in 2010 reached € 6,325 million, with an increase by 4.2% compared to 2009. Forecasts for 2011 predict an even bigger increase by 5.5% compared to 2010. In Spain, 69 insurance companies operate in the health branch. However, the first 5 companies registered a joint market share of 66.3% in 2010.
The Spanish National Health System has a free extensive network of health centres and hospitals throughout the country which offer urgent care, primary and specialised healthcare services, and hospitalisation. Only dental care has a very limited free coverage for almost exclusively dental extractions and oral cavity diseases.
The Spanish Health System combines both public and private healthcare and within each Region (Comunidad Autónoma) free healthcare is given to those who contribute to the Spanish Seguridad Social (social security). The main disadvantages of the public health system are the long waiting lists for surgical procedures, the inconvenience of room sharing by at least two patients and the difficulty in choosing doctors and hospitals.
The private healthcare system cares for approximately 2 million people – according to ICEA, the Spanish insurance association – as of December 2010. The Spanish legislation allows two main private insurance options:
Healthcare Assistance: the insurance company supplies the insured with a list of medical and hospital assistance, no coverage being granted outside the list.
The number of people buying this kind of insurance increased by 4.7% to 8.8 million in 2010, for a total premium income of € 5,354 million.
Expense Reimbursement: the insurance company reimburses the insured for all medical and hospital invoices paid during the policy validity period, usually with the application of a 10-20% franchise and fixed upper limits for each medical treatment. The insured has free choice of doctors and hospital. The policy limits the coverage to an annual aggregate insured sum.
The number of insured people decreased in 2010 by 1.2% to 887 thousand, but total premium income increased by 4.9% compared to 2009 to € 704 million, with an increase by 5.4% of group insurance compared to individual insurance.