Even though Spanish citizens went to the polls this summer, Spain still lacks a government. If the main political parties cannot form a coalition, a new general election may be called soon. To avoid this outcome, negotiations are underway between the Spanish Socialist Workers’ Party (PSOE) and Sumar – itself a coalition of 15 smaller left-leaning parties –to form a central government coalition. Sumar continues to push on a range of health policy reform proposals and initiatives, and PSOE, keen to clinch a deal, have shown willingness to compromise. This culminated on 24 October 2023, with a formal pact detailing the agreed policy proposals for the PSOE-Sumar coalition.

As this leftwing coalition remains the most likely scenario, Marwood has taken a deeper look at the key health policy proposals contained in the October Pact. As many Spanish Autonomous Communities (ACs) have themselves pointed out, the majority of these proposals would be hugely expensive to implement, and in some cases are outside of the central government’s remit. Investors considering healthcare assets in Spain will benefit from understanding which health policies may be pursued in the next legislature. Even if the ultimate jurisdiction and decision-making power over these remains with ACs, a PSOE-Sumar coalition could push elements within the Pact, marking the direction of travel for Spanish health policy over the next 4 years.

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Complex Negotiations Remain Central To PSOE Retaining Power

Forming the PSOE-Sumar leftist coalition in Spain continues to hinge on the ability of the two parties to agree on a range of issues. Top of Sumar’s healthcare wish list is the expansion of access to public-pay services, and the highly visible issue of growing waiting lists in the Spanish National Health Service (SNS). Another important initiative remains the previous coalition’s flagship proposal—the Equity Bill—which seeks to limit outsourcing from AC health departments to independent providers. While Sumar continues to champion this change due to their ideological opposition to the role of private healthcare providers, they have also pressed for policy changes across a wide number of sectors.

Coalition Promises To Expand Public-Pay Healthcare Services And Eliminate Waiting Lists

Table 1. PSOE-Sumar Coalition Health Pledges

Source: PSOE; Sumar; Marwood Analysis


Although PSOE has yet to secure the parliamentary support necessary to achieve a sufficient majority and form a coalition government, the incumbent Socialist Party appears most likely to lead Spain’s next government. The formal pact between PSOE and Sumar announced in October 2023 signposts towards the key proposals comprising the coalition government’s future health agenda.

But healthcare policies in Spain remain in the balance. Even if PSOE and Sumar govern, investors will need to wait until the new coalition government have their feet under the table to see which elements of the pact are taken forward. Marwood tracks the development of European healthcare policies, from policy pledges during election campaigns, to the drafting of legislation and enacting of new regulations. Marwood’s London Team can assist in understanding the complexities of regulatory, legislative and policy environments and keep an eye out for what the future may bring, helping investors scrutinise a target’s management plans and price assets robustly.



Rosa Juarez is a Director of UK and European Healthcare Advisory at the Marwood Group. Ms. Juarez has worked on a range of projects across health and social care in the UK and major European countries, providing insights on regulatory, reimbursement and policy outlook for investor clients. Prior to joining the Marwood Group, she held senior management positions within England’s National Health Service, with key responsibilities including strategic, operational and financial planning. Ms. Juarez holds a Master’s degree in international health policy from the London School of Economics and Political Science


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