A new audit puts the amount owed to Valencia’s public health system at €1.17 billion for care provided to patients from other regions and countries over the past decade. Published by the Sindicatura de Comptes, the figure exposes a major flaw in Spain’s healthcare compensation system and leaves the Comunidad Valenciana with the country’s largest unpaid balance for primary care.
The audit finds that the mechanisms meant to reimburse Valencia for treating non-resident and foreign patients do not work. The current system, which uses the Fondo de Cohesión Sanitaria (FCS) and the Fondo de Garantía Asistencial (FOGA), moves slowly and relies on outdated tariffs. It also lacks enforcement. Payments depend on whether other regions and countries choose to pay. Late transfers carry no penalties, and the Ministry of Finance makes no annual deductions.
In July 2025, a portion of the accumulated debt was finally paid off, but €19.4 million in outstanding claims still remain on Valencia’s books.
Between 2013 and 2024, Valencia treated thousands of patients from other Spanish regions and 38 foreign countries, including the UK, France, Germany and Portugal. Still, €798.9 million in costs remain unpaid, mainly because the FOGA has lacked proper legal development since 2012. The audit also notes that specialized emergency care and urgent treatments are excluded from compensation calculations, widening the financial gap.
Valencia’s case is unusual. The region is home to more than a third of Spain’s foreign residents and leads in billing for non-resident care. But cross-border compensation depends on the INSS and whether debtor countries pay. Interest on late payments is optional and rarely used, while European rules allow long payment periods. So, European countries still owe €700 million, with €257.1 million directly linked to Valencia. Another €28.7 million is owed by countries with bilateral agreements, including Andorra, Chile, Morocco, Brazil, Ecuador and Peru.
Valencia’s health authorities also use outdated tariffs to bill foreign patients, often set lower than those in other regions that use public pricing models. The Ministry of Health deducts 20% and 40% from certain inter-regional claims without technical explanation, leaving millions unpaid. Only treatments at officially accredited centers can be billed, so many services provided are excluded from invoices.
Information from the Ministry of Finance, as of June 2026, Valencia’s average payment period for commercial operations was 24 days, while healthcare payments across Spain reached €4.1 billion for the month. Healthcare remains one of the largest ongoing expenses, while also generating large debt.
Ministerio de Hacienda
Despite yearly claims by the Generalitat Valenciana and the regional president, the central government’s last official response was in 2022. The audit calls for stronger action and better cost control, especially for non-accredited patients. Meanwhile, €80.6 million in costs from 2012 to 2024 were never invoiced and remain unclaimed, while €67.1 million billed to private patients is still mostly unpaid.
These findings echo wider concerns about Spain’s healthcare funding, including reports of hospital financing shortfalls in Alicante, as seen in previous reports. Ongoing underfunding and weak compensation rules threaten the sustainability of public health services, especially in regions like Valencia that carry a larger share of the cost.
The current system leaves Valencia exposed to outdated rules and missing payments, while giving the region limited use against debtors. Unless the national government enforces stricter compensation procedures and updates tariffs, Valencia will keep subsidizing care for outsiders at its own expense. The shortfall directly affects the financial stability of one of Spain’s basic healthcare providers.
