Read the Conversation
Meeting highlights:
- EY’s role across the ecosystem: EY collaborates with corporates, governments, and stakeholders throughout the Spanish healthcare system, supporting initiatives that improve access, quality, and innovation while contributing to long-term system development.
- Key structural challenges: Spain faces pressure from rising healthcare costs linked to aging demographics and innovation, uneven access across regions, and shortages of physicians, all of which strain the sustainability of universal coverage.
- Investment dynamics and opportunities: Private equity activity has expanded over the past decade, with increasing participation from scientific experts and specialized consultants; the market remains fragmented, offering significant room for consolidation and growth, particularly given Spain’s strong role in clinical trials.
- Personalized medicine and digitalization: Advances in personalized medicine and genetic research, backed by EU programs, alongside private hospitals’ investments in AI and data-driven tools, represent key opportunities to enhance treatment outcomes and efficiency, while public healthcare progresses toward interoperability.
- Governance and collaboration: Frequent political changes challenge continuity in healthcare planning, underscoring the need for long-term strategies and stronger public–private collaboration to unlock innovation and improve system performance.
EF: Could you elaborate on your role at EY and your company´s contribution to the Spanish healthcare sector?
BS: My role at EY is to coordinate all our firmwide activities across audit, consulting, transaction, tax, and legal services. I lead the health unit, responsible for delivering the best service to clients, society, and governments.
Our purpose is to build a future with confidence; EY’s new claim, which means supporting clients from every angle, working with both corporates and governments. In Spain, we collaborate closely with the Ministry of Health to reshape processes and tackle key challenges.
We help corporates grow their business, introduce tools to improve clinical quality, expand patient access, and apply AI to clinical decisions. Our goal is to add real value to society, improve the healthcare system, and make a difference.
We work across the entire healthcare ecosystem: with financial institutions, private equity, and sponsors to develop companies; with government and technology firms to bring products to market; with patient associations; and with pharmaceutical companies to improve market access and client support.
EF: You mentioned tackle challenges- what are the main issues to address when it comes to the future of Spain’s healthcare market?
BS: The first challenge is Spain’s rapidly aging population — one of the highest rates in Europe — and it keeps growing. Immigration helps, but not enough to offset the decline. Birth rates remain very low. In fact, as in other countries, we now have more pets than children, a trend likely to continue.
The second challenge is cost. Aging alone increases healthcare spending, but new Medtech and innovative pharmaceuticals add even more pressure across the value chain. Per-capita costs will keep rising, and we do not have the resources to fully cover them. Despite a fully funded national health system, more than 25% of the population pays for private insurance on top; a remarkable figure that continues to grow despite financial pressures. Private health insurance penetration has risen steadily over the past decade, showing that public coverage alone is not enough. Financing the ecosystem remains a major issue, with annual deficits.
Access is also unequal across Spain’s 17 regions. Expenditures, access to medicines and Medtech, and the quality and efficiency of care vary widely. Since regions fully manage their healthcare budgets, there is no law to correct these inequalities.
Another challenge is the physician shortage. Admission to medical studies is limited by numerus clausus in public universities. Although new programs have opened and numbers are rising, it is still not enough. Shortages in key specialties lead to long waiting lists and increased pressure on the system.
Despite these significant challenges, Spain remains strong. We offer universal coverage and high-quality services. When compared with countries outside Europe, the value of what we have becomes very clear.
EF: What is the strategy for making smart investments? How is EY helping to overcome the challenges in the system?
BS: My main area is supporting transactions with private equity, helping the system address its challenges. We also work closely with the administration on initiatives such as improving patient protocols, implementing AI, and using data-driven decision-making.
For example, we are working with the Ministry of Health on a public project to implement genetic disorder analysis. This includes building analytics solutions and a national plan to cover all genetic diseases, sharing information across autonomous communities, and eventually across Europe. Projects like these strengthen the healthcare system on multiple levels.
Regarding investment, Spain saw private equity activity later than the UK, Germany, or France, but now hosts a wide ecosystem. Many European and global firms are entering the market. The system remains fragmented, leaving room for consolidation. Hospitals are the only subsegment largely consolidated; in most others, the top five companies hold less than 30–40% market share.
This opens opportunities for investors to consolidate, scale in Spain, and expand into Europe. Spain is attractive thanks to its qualified, cost-efficient workforce and favorable regulations in areas such as CROs. Notably, half of all new clinical trials in Europe take place here.
EF: Why was Spain late in attracting private equity, and what makes it attractive now?
BS: People were not investing in areas they did not understand. Now, that has changed. Private equity firms have professionalized, building dedicated healthcare and life sciences teams. Venture capital and small-to-medium funds are also fully focused on the sector.
Today, investment teams include technicians, biologists, and chemists, not just finance experts. Specialized consultants help translate complex healthcare concepts into business terms that investors can act on. This combination has driven a rise in transactions, not only in Spain but across Europe. In Spain, investors initially focused on larger, more established markets, but in the past 10–15 years, activity here has accelerated significantly.
EF: I would like to get your perspective on how actively Spain is integrating high technology. How do you see the healthcare system shifting in the coming years?
BS: Personalized medicine is something that should be expanded across Europe. For many treatments, particularly in specialties like oncology, it has been shown that some drugs are not effective for certain patients, yet these treatments are still being administered. We need to progress more with personalized medicine, improve our understanding of disease management, and invest in genetics. This is on the agenda of the European Union, which is supporting and financing different programs. One of these programs is the one we are currently working on. However, the level of understanding and implementation of personalized medicine is still developing across Europe. It is an area that definitely needs to advance.
EF: What is the current level of infrastructure and awareness in Spain around AI, data, and digitalization?
BS: We are still far from where we should be. There is a big difference between the public and private sectors. Private hospitals are investing in data-driven decision-making and starting to implement AI solutions to support clinical decisions.
Public hospitals, however, still struggle to share information, even within the same region. The mindset is beginning to change, but in Spain, it is still not possible to easily share an electronic medical record between two regions.
There is no common database for patients to have all their information accessible throughout the public system. A European regulation promotes cloud-based access to clinical data, but it is still not implemented. For years, resources went into building silos, and now we are trying to dismantle them. The change has started, but it will take time.
EF: What is one challenge in the sector you would like to address? Is there a topic close to your heart where you would like to see more dialogue?
BS: One of our biggest challenges is that every four years, elections change everything. We get a new Ministry of Health, and in the autonomous regions, new local ministries. This means a complete turnover of managers across most healthcare organizations.
It is the opposite of having a long-term plan with clear medium- and long-term investment priorities. The lack of understanding between political parties means there is little agreement, and decisions are often reversed rather than aligned.
For me, this is the key issue. There are many small improvements we could make, but the main challenge is navigating political change and the lack of continuity, which has a huge impact on the system. We are in the middle of a storm. Without long-term planning, corporates, consultants, and other stakeholders can only stop the bleeding and provide tactical fixes. What is really needed is a broad, long-term plan for society, particularly for healthcare.
Another key point is public-private collaboration. This could make a real difference. The public sector funds nearly all treatments, but part of society still sees the private sector as a disruptor, assuming that profit takes away resources. The opposite is true: the private sector must be profitable to support innovation and introduce new solutions, which benefit society and government alike.
Public-private collaboration was once stronger but has decreased. We need a shared understanding of who is adding value and in what ways. Some regions have strong collaboration between corporations and public administration, but most of the population does not recognize it.
Improving regulation, access, and support for companies to innovate without unnecessary barriers would also help. There is still a huge lack of efficiency across the value chain because the system does not promote it.
