Over the last five years, Madrid has increased its health spending by almost 31%, reaching in 2023 an estimated 10.85 billion euros. This rise far surpasses the national average, which remains below 20%, underscoring Madrid’s commitment to strengthening its health system, as reported by the Instituto Coordenadas de Gobernanza y Economía Aplicada.
The evolution of health expenditure has varied among autonomous communities, yet all face a common challenge: the structural waiting lists. An ICGEA study analyzing spending in recent years across the regions shows large differences between what each area needs and what it prioritizes.
In a context of economic fluctuations and pandemic-related pressures, health spending has shown notable shifts over the past five years. Between 2018 and 2020 there was a strong rise, driven largely by the covid-19 emergency. From March 2020 onward, demand for medical services, equipment and staff surged. Nationally, health spending increased from about 71.0 billion euros in 2018 to 84.5 billion euros in 2023, yet the upward trajectory appears to be tapering, with a near 1% drop in 2022 and a similar estimate for 2023, raising concerns about the system’s long-term sustainability. Not all autonomous communities followed this pattern.
Breaking down these figures by autonomous community reveals notable contrasts. Some regions trimmed spending while others increased investments, with Madrid leading the way by posting an increase of roughly 31% since 2018 and an estimated 2023 outlay of around 10.85 billion euros. This amount accounts for more than 43% of Madrid’s total budget and stands well above the national average, highlighting the region’s strong commitment to health system strengthening.
The sustained growth in Madrid’s health spending is reflected in a record rise in the autonomous community’s 2025 budget, signaling resilience and readiness to address current and future health challenges across the region.
Health expenditure in Spain
From 2018 to 2024, Spain’s health spending has shown fluctuations, with a national trend of modest contraction in recent years but marked regional differences. Nationally, health expenditure rose and fell in this period mainly due to the COVID-19 pandemic and the subsequent stabilization of the health system, climbing from about 70.2 billion euros in 2018 to 84.5 billion euros in 2023, a rise of roughly 20% over the five-year period.
However, 2022 recorded a contraction of around 1%, with spending near 85.1 billion euros, linked in part to the rollback of many pandemic-era extraordinary measures and a continuation of that trend into 2023, according to the latest reports.
Regarding the communities, ICGEA notes that Madrid stands out for its ongoing investment in health in recent years, becoming one of the regions with the strongest commitment to strengthening its system. Madrid’s health expenditure rose by nearly 31% between 2018 and 2023, with 2023 spending surpassing 10.85 billion euros. Investments focused on improving primary care and hospitals, upgrading infrastructure and facilities, hiring staff, reducing waiting lists, and advancing digital transformation, among other measures.
Valencian Community increased from 7.1 billion in 2018 to 9.2 billion in 2023, a 29% rise, with investments aimed primarily at cutting waiting times and modernizing hospital facilities.
Andalusia reported a five-year growth of 28%, reaching 12.2 billion in 2023, with funding aimed at strengthening primary care and expanding the health workforce.
Catalonia followed with a growth of about 25%, rising from 10.6 billion to 13.3 billion euros, focusing on primary care and hospital infrastructure improvements.
The Basque Country also increased its health budgets, though by a more modest 18%, from 3.9 billion in 2018 to 4.6 billion in 2023, prioritizing primary care, digital transformation, and hospital infrastructure upgrades.
Structural Challenge
Waiting lists have become one of the major structural challenges of Spain’s health system. In recent years, rising demand for health services combined with shortages of resources and staff in certain areas has produced longer waits in both primary and specialized care. Despite regional efforts to address the problem, disparities between regions and the lasting impact of the COVID-19 pandemic have deepened the situation, with surgical waiting times averaging 121 days nationwide and waits for specialist consultations averaging 94 days, according to the latest data from the Ministry as of June 2024.
In recent years, much of the effort by communities has aimed to lower waiting times. Madrid, the Basque Country, and La Rioja have stood out as the most noticeable examples of this commitment. The Madrid plan for 2022-24, backed by 215 million euros, has helped Madrid consolidate as the region with the shortest surgical waiting times, with an average delay of 47 days, 74 days below the national average, followed by the Basque Country with 61 days and La Rioja with 64.
For waits to see a specialist, the Basque Country has the shortest time at 49 days, 45 days shorter than the national average, followed by La Rioja with 58 days and Madrid with 60 days of average delay, according to the latest figures.