The health sector, essential for the well-being of the population and an economic engine for society
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- The ecosystem of the private healthcare sector transcends the field of healthcare and has an impact on society and on the productive sectors of the country’s economy: in 2021, healthcare expenditure reached 10.4% of GDP, with at least 3.1% of this being of private origin.
- 7.5% of employees in Spain work in activities related to the sector, 60% of whom are women. There are more than 198,000 companies in the health sector.
- Of the 900 clinical trials in Spain, 86% are privately financed. In addition, 34.8% of the patents filed were private.
- In the healthcare sector, 55.6% of hospitals are privately owned, performing 31% of surgeries and 24% of emergencies.
- In this report, the IDIS Foundation analyses five areas of private sector impact: economy and growth; employment, business and social equity; industry, investment and innovation; training; and healthcare, analysing aggregate data in all of them and demonstrating that private initiative is an unquestionable part of the health, economic and social system.
Madrid 13 March 2024.-The healthcare sector is one of the key pillars of the Spanish economy, to which it contributes 10.4% of Gross Domestic Product, very close to that of tourism and, therefore, one of Spain’s main economic and social drivers. The private initiative in the health sector is an unquestionable key element, as it has a direct impact on the provision of goods and services in different areas of society and in the productive sectors of the country’s economy: not only does it drive, promote and cover needs in the health sector, but it also plays a central role in the generation of economic value (between 54% and 58% of total health expenditure requires the private sector to provide services), the creation of qualified employment (with 7.5% of employees in Spain), the promotion of innovation and efficiency (where 34.8% of the patents presented were private), as well as patient care, beyond the specific field of healthcare.
“Our healthcare system is made up of communicating vessels. Not only the public and private sectors, but all the sub-sectors that make up the system are communicating vessels. If measures are taken that harm one subsector at a given moment (for ideological reasons, for example), not only does this one suffer, but also the rest and, with it, the whole of a sector that is essential for the welfare state of our country and one of its economic engines”. This was stated by Juan Abarca, president of the Institute for the Development and Integration of Healthcare (IDIS Foundation), during the presentation of the conclusions of the report ‘Monitor of Business Activity in the Spanish Healthcare Sector’, a rigorous study developed by the IDIS Foundation, based on data from sectoral organisations and the various ministries involved in the activity; Data that show what private activity in a sector as diverse as the health sector means for the country and its standardisation within the health system itself, analysing with indicators created ad hoc its impact in five areas of study -economy and growth; employment, business and social equity; industry, investment and innovation; training and research; and healthcare- with repercussions in 11 ministries.
Economy and growth
The healthcare sector is one of the key pillars of the Spanish economy, and private healthcare expenditure accounts for 3.1% of the Gross Domestic Product. The turnover of companies in the healthcare sector with a direct and indirect impact exceeds 75,134 million euros, which represents 5.58% of total GDP. Thus, for example, it is noteworthy that the management of private hospitals generated a turnover of 12,400 million euros in 2022, with an increase of 5.5% compared to 2021, the turnover of health insurance in 2022 reached the figure of 10,908 million euros (being 0.81% of GDP in 2022).
On the other hand, it is noteworthy that the pharmaceutical industry increased its sales abroad by 55%, reaching 27,442 million euros, which represents 7.1% of total exports in Spain.
Employment, business and social equity
As the report shows, the private health sector employs more than one million people in Spain (direct and indirect impact). It is estimated that the total number of workers in the health insurance sector amounts to 6,892 people, workers in pharmacies to 70,122, the social and healthcare sector to more than 160,000, the technology sector to around 130,500 jobs and the pharmaceutical industry to 259,000 jobs.
On the other hand, the health sector has a business fabric of 198,869 companies, 5.7% of the total number of entities in Spain, making it one of the main generators and drivers of employment. In terms of equity, it is worth noting that 60% of professionals in the health sector are women and that, thanks to the work of pharmacies in rural areas, 90% of the population in small rural municipalities and 70% of micro-municipalities have access to health services.
Industry, investment and innovation
As the report shows, after the COVID-19 crisis, the healthcare technology market has grown by 7%, with a 5% increase in employment.
On the other hand, the pharmaceutical industry is also a strategic sector in Spain due to its capacity for investment in R&D, production, exports and quality employment. As explained by the Director General of the IDIS Foundation, Marta Villanueva, “this industry is the third exporting force in our country with 103 production plants and 1 out of every 5 euros invested in R&D by companies is contributed by the pharmaceutical sector. Likewise, the biotechnology sector plays an important role in relation to research, with more than 900 clinical trials authorised in Spain, 86% of which are privately funded”.
Innovation in the health sector accounts for a large part of the interest in science in terms of expenditure, being the second sector that receives most funding, behind industrial production and technology. In fact, the PERTE for Vanguard Health foresees 19.5% private funding for R&D, personalised medicine, data and the digital transformation of the sector.
The IDIS Foundation’s commitment to digital transformation is reflected in the launch of the miHC project, financed with private funds, which will allow the interoperability of private hospitals, as well as the sending of the required clinical documentation in digital format to any doctor. “This means that the adhesion of all hospital groups will allow 55.6% of Spanish hospitals to have an interconnection of electronic medical record data”, as Marta Villanueva pointed out.
Healthcare
55.6% of hospitals in Spain are privately owned, accounting for 32% of the hospital beds in Spain and 70.5% of the socio-health centres. Private hospitals perform 31% of surgeries and 24% of discharges and emergencies in Spain. In terms of high-tech medical equipment, the private hospital sector accounts for 52% of MRIs. On the other hand, private hospitals with substitute agreements carried out nearly 574,000 surgeries, more than 10 million consultations and attended nearly 2.5 million emergencies and more than 550,000 hospital discharges.
From the point of view of savings, it is important to highlight the impact of administrative mutuality. In this respect, we can say that the population covered by this model is 1.73 million people, i.e. approximately 82% of the total, which represents a saving of almost 571 million euros.
At the same time, it is noteworthy that 92% of the ambulances in operation in Spain for any of the services are privately owned and that the companies supplying medical gases generate direct employment for 1,800 people, providing services to 888 centres and 187,000 public and private beds.
Training and research
Finally, the report also shows significant data such as the fact that 63.43% of Spanish universities are private, of which 37.09% offer studies in the field of health. Furthermore, it is relevant that 27.7% of undergraduate students in health sciences did so in a privately owned centre, that 34.54% of master’s degrees in health are taught by private universities and that 44.6% of students enrolled in intermediate studies in the field of health and 61.8% in higher education did so in private centres.
Support from the entire health sector
Representatives of the sectoral organisations involved in the field of health participated in the presentation of the report, supporting the work of the IDIS Foundation and analysing, from their perspective, the indispensable contribution of their areas of activity. Josune Méndez, secretary general of the Association of Dependency Services Companies (AESTE), wanted to highlight “how the report highlights the contribution of the care sector to many of the challenges we face as a society – such as the sustainability of the NHS or the need to offer a care model that responds to the individual needs of people – and because it provides in-depth knowledge from a transversal viewpoint, helping to set aside the private-public debate, which results in greater social recognition of the sector”.
The President of the Spanish Private Healthcare Alliance (ASPE), Carlos Rus, for his part, emphasised “the constant effort of the hospital healthcare sector to ensure excellence in medical care by prioritising quality and personalised attention, mentioning the high level of training and commitment of the professionals, as the backbone of the system. Together with the professionals, he highlighted the commitment of the centres to innovation and the incorporation of cutting-edge technology that allows them to deal with the high complexity in the provision of services”.
Javier Urzay, Deputy Director General of Farmaindustria, focused on R&D as the raison d’être of the pharmaceutical industry that “every year increases its investment in our country, beating its own record in 2023, with 1,395 million euros, which represents 20% of all industrial R&D in Spain. This firm commitment to research is based on a successful model of public-private collaboration, together with hospitals and research centres, which has positioned Spain as an international benchmark in clinical research, as well as strengthening the productive fabric and open strategic autonomy. All of this, always with the ultimate aim of improving people’s health, quality of life and well-being.
From the Spanish Federation of Health Technology Companies (FENIN), its Secretary General, Pablo Crespo, considers that “this work by the IDIS Foundation confirms the essential role of the health technology industry in improving the health and quality of life of the population, in the generation of wealth for our country and our leadership in the digital health of the National Health System. Given that new healthcare technologies will allow us to have a more modern and efficient healthcare system, as well as a healthier and more productive population, we need a culture in which investment in healthcare technologies is a strategic priority in order to achieve more personalised healthcare and better health outcomes,” he said.
The Secretary General of the Spanish Union of Insurance and Reinsurance Entities (UNESPA), Luis Miguel Ávalos, wanted to highlight the involvement of the insurance sector in healthcare activity, from its health branch, “by offering innovative treatments with complementary therapeutic options and facilitating access to healthcare services; services whose provision relieves the workload of public centres, which once again highlights the role of allies, and not competitors, of the public and private sectors”.
This analysis,” concluded Marta Villanueva, “shows that to talk about private initiative in healthcare is to talk about improving health, but also about driving the economy, employment, responsible innovation, training and collaboration. And she recalled that public-private collaboration is essential in most of the key social sectors, and of course in the health sector as well. This is why it must be normalised, because it is the healthcare activity itself that makes collaboration inevitable. If this fails, the activity fails, the system fails and society as a whole suffers”.
