The number of private health insured grows more than 4% in 2020

ABC Health



In 2020 the Private sanity reached the 11 million insured -with mutual members-, which represents an increase of 4.4% compared to the previous year. This is clear from the eleventh Report “Private health, adding value: Situation Analysis 2021” developed by the IDIS Foundation.

“Based on the figures and data collected in this report, private-public cooperation and the use of all available resources is confirmed as essential for the health system to be viable, efficient and capable of providing the best health and health outcomes possible. The sum of all is what adds value to healthcare, to society and to the patient and their environment in particular. The enormous challenges of the present and of the future require an adaptation of our health system to the needs it poses and, for this, from the IDIS Foundation we have proposed to society the “Manifesto for Better Health”, which encompasses 10 principles whose path can contribute to building a system that meets the needs and demands of citizens by establishing a more precise and personalized medicine», Assures Juan Abarca, president of the Institute for the Development and Integration of Healthcare (IDIS Foundation), during the presentation of the report, which assesses the progress of digitization and the contribution of the private sector to the objectives of sustainable development (ODS) marked in the 2030 agenda.

For his part, the general secretary of IDIS, Ángel de Benito, indicates that “the updating of the data presented today is a source of satisfaction for an organization such as the IDIS Foundation since, despite the unprecedented changes brought by the pandemic, the private provision and insurance health sector have demonstrated their high involvement through the availability of resources, collaboration and rapid adaptation to the new environment, improving accessibility, equity, the quality of health care and the care of patients. patients ».

The global analysis of the contribution of the data of the Report shows that the privately owned healthcare sector represents 29.2% of total healthcare spending, which represents a high weight in the Spanish productive sector (2.7% of GDP), and it makes Spain one of the countries where the weight of private health spending over the total is greater. Also noteworthy is the evolution of compound annual growth, 3%, 2 percentage points above public health spending.

The release of resources from public health that is attributed to private health has its most reliable explanation in the 9.2 million insured -not mutualists- who contribute to the discharge and savings of the public health system. Estimates indicate that the savings generated by private insurance would be between 1,368 euros per year (if the patient exclusively uses the private system) and 506 euros (if he makes a mixed use of healthcare, using both public and private healthcare).

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In line with what has been observed in previous years, the insurance sector continues to register significant increases, both in the number of insured and in the volume of premiums. «In 2020, 11 million insured -with mutual insurance-, which represents an increase of 4.4% compared to the previous year (by type, 77% of the insured correspond to health care, 16% to administrative mutualism and the remaining 7% to reimbursement of expenses) ”, explains Marta Villanueva, general director of the IDIS Foundation, who discovers that, in all the provinces, the number of insured is growing. At the level of premium volume, it is estimated that in 2020 they have exceeded 9,000 million euros, which represents an increase of 5.1% compared to 2019.

Accessibility and activity of the private sector

In 2018, private hospitals carried out 30.2% (1.6 million) of surgeries, 23.7% (1.3 million discharges) and 24.4% (7.4 million) of emergencies throughout the National territory. Namely, 1 in 3 surgeries, 1 in 4 emergencies or 1 in 5 consultations are attended in the private health sector, which has a staff of 441 hospitals in Spain, which represents 56% of the total number of hospitals in our country, with 50,960 beds (32% of the total of the existing ones). At a geographical level, Catalonia, Madrid and Andalusia remain the autonomous communities with the highest number of private beds. Within this health care, the performance of 30% of the complex surgical activity is noteworthy.

This availability of centers and their decision-making capacity mean that the private sector can collaborate and engage with the public system, since, as stated in the CEOE’s White Paper on Health, an exclusively public scenario could not face alone the demand. In this way, the collaboration of the private system with the public sector is materialized in the form of concerts, administrative mutualism (a system with a high degree of satisfaction -83.4% of mutualists choose to be served by an insurance entity-) and Administrative concessions, a model that saves resources to the public system and under which they currently operate 9 hospitals in Spain (administrative concessions that include health services).

State-of-the-art technology and ‘digital patient’

In relation to research, the participation of the 98 private centers participating in 567 clinical trials between 2016 and 2020 is essential and, in addition, shows a very high recruitment rate (advance data from the 29th publication of BD Metrics) . And, with respect to the commitment to the acquisition of state-of-the-art technology, the possession data of the 52% of MRI equipment, 44% of PET and 34% of CT.

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Catalonia, Madrid, Andalusia and the Valencian Community are the ones with the most high-tech equipment. But, in addition, it is very significant that the sector has cutting edge technology for the treatment of multiple diseases, such as cancer or neurological diseases. In this sense, it has a large number of linear accelerators for next-generation radiotherapy and brachytherapy; is a pioneer in the use of PET / MRI for a more accurate diagnosis and a 90% reduction in radiation; has built in the last year and for the first time in Spain two centers of protonotherapy, available for patients with cancers in areas especially sensitive to radiation; and has equipment HIFU (High Intensity Focus Ultrasound) in 3 centers for the treatment of neurological processes without the need for surgery.

The transformation in assistance that the pandemic has brought with it has not been unrelated to the private sector. It has found in the entities that form it allies to accelerate virtual health care, grow telemedicine by 153% and incorporate artificial intelligence (AI) and other technology tools into workflows. As an example, 69% of healthcare organizations are testing and adopting AI and 39% have inclusive or human-centered design principles to facilitate collaboration between people and machines. “Undoubtedly, virtual healthcare and face-to-face healthcare would have to collaborate to offer effective, reliable, safe and trustworthy services in order to guarantee good health results, a satisfactory patient experience and sustainability of the system itself”, explains the director General of the IDIS Foundation.

Public-private collaboration

Public and private health manage to create a single network that provides our country with health care not only of maximum excellence, but also accessible. The use of all available resources, regardless of their ownership, allows relief of care pressure and financial to public health and avoid duplication, while offering health care of recognized and proven quality.

As an example, according to data from the Spanish Private Health Alliance (ASPE), private healthcare has come to serve 19% of patients affected by Covid-19 and 14.2% of patients admitted to intensive care units. In this regard, the IDIS report highlights that only 1 in 10 euros of public health spending was allocated to private-public collaboration, taking into account that such collaboration occurs in the relief of waiting lists in the form of concerts, transport health, respiratory therapy and dialysis. At the regional level, Catalonia, Madrid, Andalusia and the Canary Islands are the ones that allocate the most resources to the collaborative game. Another formula is the administrative concessions, today there are already 9 hospitals that operate under this model.

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On the other hand, it stands out that around 1.7 million civil servants of the central administration covered by the administrative mutualism regime in Spain choose private insurance and healthcare coverage. According to Marta Villanueva, «this model provides efficiency in the provision of a public service, since the per capita expenditure of the covered population is substantially lower than the per capita public health expenditure. In this sense, it is estimated that the average MUFACE premium in 2020 will be 917 euros per year per insured, while the public health expenditure per capita for the same year is 1,368 euros (does not include pharmaceutical expenditure or expenditure for mutual funds ), which represents a saving of 451 euros for each mutual for the Administration ”.


The report shows that this sector employs 278,291 professionals in our country (It is estimated that 61% work in the outpatient setting and 39% in the hospital setting). It also shows how the training of professionals is gaining ground in private healthcare, offering 261 specialized training places, 46 more than the previous year.

The report shows that the sector has different certifications that certify the quality of its centers (such as the different ISO standards, OHSAS 18001, the EFQM European excellence model or the Joint Commission, SEP, SGE-21 accreditation, among others). In addition, since 2015 the IDIS Foundation has promoted the QH (Quality Healthcare) Accreditation, already in its 8th call and with 136 accredited entities.

Private healthcare is also committed to meeting the SDGs established by the UN in 2030. In this line, it carries out various activities with its entities to put an end to poverty (SDG 1), improve education, especially in relation to students and professionals in the sector (SDG 4) or apply active policies to reduce inequalities or equality gender (SDG 10 and 5) and job creation (SDG 8). It is also committed to innovation (SDG 9), environmental policies aimed at the care and sustainability of the environment (SDG 13) and the promotion of alliances in its joint work with both public and private entities (SDG 17).

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