Patients in Spain waited an average of 102 days for an outpatient consultation and 121 days for a scheduled operation, up from 58 and 74 days respectively around two decades earlier. That represents increases of 44 days for consultations and 47 days for operations. The figures are set out in an analysis of the National Health System (SNS) that identifies waiting lists as the main obstacle to equal access.
Carlos Alberto Díaz, director of medicine at Sanatorio Sagrado Corazón and head of the Health Economics and Management degree at Argentina's Universidad ISALUD, reviews the work on his blog ‘Gestión y Economía de la Salud’. The underlying paper, ‘Equidad en el Sistema Nacional de Salud: ayer, hoy, mañana’, was published by Pompeu Fabra University and written by Vicente Ortún-Rubio, professor emeritus at UPF and principal investigator at CRES, and Rosa Urbanos-Garrido, professor at the Complutense University of Madrid and former president of SESPAS.
The pressure has also reached primary care. From 2019 to 2025, the share of people waiting more than a day to see a family doctor rose from 50.6% to 70%. For those unable to get an appointment within 48 hours, the average wait increased from 5.8 to 9.2 days. Spain's health services are administered by autonomous communities, where appointment systems differ.
The authors argue that adding capacity has dominated responses to waiting lists. They say regularly reviewing people who are waiting could help assess whether the proposed treatment remains appropriate and how urgently it is needed.
Long waits are among the main reasons people take out private health insurance, alongside the option of bypassing primary care. Excluding mutual insurance scheme members, 11.2 million residents, almost 23% of the population, had private cover, compared with 18.7% in 2019. The analysis says this spending accounts for only 6-7% of total health expenditure.
Geography is another dimension of access. In its 2026 report The Geography of Choice, the OECD reported that 28% of residents in Spanish functional rural areas could not reach a general hospital within 45 minutes, compared with an average of 8.5% in the Portuguese rural areas included in the comparison. The OECD said the largest gaps in Spain were concentrated in interior areas and parts of the Spanish-Portuguese border; access worsened with increasing rurality, especially in areas with a village but no town.
Mental health shows another gap: socioeconomic disadvantage is associated with greater need for care and less access to specialist consultations, particularly for women. Only half of those who experienced a mental health problem received care through the public system. Women on lower incomes tend to replace psychotherapy with psychiatric medication, while access through primary care and emergency services follows a different pattern from specialist care.
Funding also varies sharply between autonomous communities. In 2023, the best-funded community received more than 26% above the per-person adjusted average, while the least-funded were 6% below it. The analysis attributes approximately 80% of inequality in social spending to funding. It also says the Interterritorial Council has not provided effective cohesion and that Spain lacks an explicit debate on how much territorial inequality is acceptable.
The paper places health equity within wider social conditions, arguing that opportunities in childhood matter and that education is a key policy for shaping the distribution of opportunity before income is earned. It also points to secure, dignified work with scope for development and to institutions' ability to turn resources into results. Questions about institutional accountability in Spain's public life have also been examined in this related report.
