Public health congestion with COVID-19 gives the biggest boost to private health insurance in a decade

Private health insurance has been experiencing unstoppable growth for years, but the congestion of public health caused by the coronavirus has given them the biggest boost in the last decade. The number of people with health care policies grew by 4.4% between 2019 and 2020, the largest year-on-year increase since 2011, according to data provided by the Insurance Business Association (Unespa).

Healthcare: years of public cuts have favored private business

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The most recent figures of the entity, corresponding to the first half of 2021, reveal that insurers entered 10.5% more in premiums than in 2019. For the first time in history, the volume of insured – among which are included mutualists, officials who choose private over public care – exceeds eleven million, 23.4% of the total population, and billing exceeded 9,000 million euros.

Companies that sell private health insurance admit that the pandemic has generated more predisposition to hire one, although the trend already existed before COVID-19. Public health waiting lists soared in 2020. Hospitals gave themselves 100% to curing the coronavirus in the face of an avalanche of very sick patients who required a lot of care and also required long stays in the ICU. This forced operating rooms to close and care for other ailments was neglected. That stoppage has resulted in serious delays in diagnoses and, in the most dramatic cases, deaths that could have been prevented.

The closing data for 2020 from the National Health System is eloquent: almost 50% of patients waited more than six months to have an appointment with the specialist, and the average waiting time for an operation was 148 days, almost five months. The consultations with the longest delay are, in this order: trauma, dermatology and ophthalmology.

The wait in the public health system

Semiannual evolution of number of patients on waiting lists and of the proportion of them with long wait, for consultations and for surgical operations. The evolution of the mean waiting time for both

Source: SNS information system | Notes: In 2019 there is a series break due to a change in the computer system in Andalusia

Miguel Ángel, 58, had had insurance for years, but had not used it until now. At the end of August he suffered a heart attack while waiting for his hospital in Madrid to perform an electrocardiogram. Three months earlier, he had gone to his family doctor to inform him that one of his brothers had been diagnosed with a genetic heart disease. Miguel Ángel was summoned for diagnostic tests in Madrid’s public health system in March 2022. “I think that if they had given me an appointment earlier, they would have seen him,” he says in conversation with

It did not stop there. “My surprise when I left the hospital after six days in hospital was that the next check-up was not until March. I was scared after what had happened to me, I needed to feel sure that everything was going well, so I went to private and they did the check-up. In December they will do it again, “explains Miguel Ángel, who adds:” I would like it to be possible in the public sector, where the best doctors and the best media are supposed to be. ”

The places where more days on average you have to wait for surgery are Castilla-La Mancha and Andalusia, while Catalonia and Aragon are at the forefront in delays for visits to the specialist.

The waiting lists in each community

Number of patients waiting for every 1,000 inhabitants in each autonomous community for consultations or surgeries. It also shows the percentage of them with a long wait and the average wait time in days

The variables: disposable wealth and dissatisfaction with public health

José Manuel-Freire, emeritus professor at the National School of Health and a former health minister in the Basque Country, believes that to explain the rise we must consider “a temporary factor linked to the pandemic”, which will disappear once the health systems recover a relative normality, beyond the two variables that always mark such a decision, in his opinion: the wealth available and the unsatisfactory public service.

“The middle classes with possible have migrated because the level of activity in the public has dropped and they have decided not to wait. There is a conjunctural aspect,” says this doctor, who has spent almost two decades as a PSOE deputy in the Madrid Assembly in charge of health matters. Some insurance companies have used the pandemic as a claim. “Private medical insurance is necessary due to the collapse of public health. They are the best way to have medical care without risking health due to the delay in care,” said Seguros Cea on its website.

The Federation of Associations in Defense of Public Health interprets that “it is probable that a sector of the population has sought an answer in private insurance” for fear of not being able to be treated in the future in public centers that could once again be overwhelmed by the health crisis. His spokesman, Mariano Sánchez-Bayle, lamented a year ago in this medium that “the worse the public sector works, the more business opportunities the private sector has.”

The private health expenditure per inhabitant in Spain is 719 euros, according to the latest data from the Ministry of Health. Households spend almost 34,000 million euros a year in this concept, which represents 2.7% of the national GDP. And 9 out of 10 euros of direct payments “are used for curative and rehabilitative care (including dental care), medicines (including co-payment), glasses and hearing aids,” according to Health.

The employers of the Unespa insurers argue that the increase in private insurance “saves costs” for the public administration and “has contributed to containing the pandemic.” The private health sector requested public compensation for its services during the first months of the health emergency. He intended that part of the funds that the Government was going to transfer to the autonomous communities would cover “the costs of the requests” that were made to them.

The sector came from a prosperous time that was broken with COVID-19. Private hospitals billed 6,775 million euros in 2020, 2.5% less than in the previous year. “The pandemic caused a moderate decline in the market for the first time in two decades,” says consultancy DBK. Sanitas reduced its profits by 11%. The CEO, Iñaki Peralta, already advances that policy prices will rise because the coronavirus “is a pathology that did not exist before,” according to this interview published in Cinco Días. Three insurers (Adeslas, Sanitas and Asisa) concentrate almost 60% of the business volume in Spain.

In which communities has the drive for private insurance been most pronounced? The Community of Madrid, the one that allocates the least resources to public health, remains at the forefront of the population that purchases these services: it reaches almost 37% compared to 33% in 2015 (almost two and a half million people); It is followed by Ceuta, Melilla and Catalunya with similar percentage growth.

In the first case, the figure is explained, in part, by the concentration of civil servants of the general administration of the State who live in Madrid. Unespa data do not discriminate between “public” insurance, that is, those of State workers who choose Muface instead of Social Security (they do not pay for it), and private (which the insured do pay). This same reason is behind the positions of Ceuta and Melilla, where many soldiers who choose Isfas reside. Castilla-La Mancha, for its part, registers a decline in the percentage of the population with health insurance in the last five years, from 20% to 15%. The regions with the least insured for health care are Navarra and Cantabria, which are still growing equally.

The figures provided by Unespa also do not differentiate between individual and group insurance. The latter are, for example, those provided by a company to its workforce. In this way, it is impossible, with the current breakdown, to know how many people, in a personal capacity, paid for private health insurance in the last year and a half.