“It’s crazy how easy it is to access a query when you need it.” “The best private healthcare, also for you.” This fall, health insurance campaigns have flooded the advertising spaces of television and social networks. It is not just a perception: the number of advertising inserts for health insurance on television has multiplied almost by five, from 2,800 on average in the months of January-March to more than 12,500 on average in October and November, according to data from the Spanish Association of Advertisers. The evolution of the first 10 months of the year shows how between April and June the insurers hardly promoted this product, to do so again, especially from September. Health insurance is the only one that has grown during the pandemic, 4.9%, according to data from the Unespa association.

The image of an overwhelmed public health care, with primary care on the verge of collapse and hospital occupied for months only with coronavirus care, could be having the effect that the previous crisis had, during which private insurance also grew. That was an economic crisis that resulted in underfunding of public health services and an increase in waiting lists and a negative perception of public services. In the last decade, the number of people with private insurance has increased by more than two million people. In 2019, 22.5% of the population had private insurance (10.6 million people). In 2011 there were 8.7 million (18.5%). It is too early to know exactly what the effect of this crisis is, because the reports of the Ministry of Economy are annual, But Juan Oliva, an expert in health economics at the University of Castilla-La Mancha, points out some clues: “What we do know is that during the previous economic crisis, despite the fall in family income, private insurance did not only they did not lose clients, but the numbers of insured persons increased slightly. After the crisis, even more ”.

The delays in her husband’s medical care have decided Ana Plazuelo’s family, who lives in Castilleja de la Cuesta (Seville), to take out health insurance. Until now they had neither needed nor wanted to resort to private healthcare, because they were convinced that the best way to defend public healthcare is to use it and claim when something does not work well. In October they made an appointment in primary school to consult for a series of tension attacks and tachycardias. “They gave it to us for three weeks later,” recalls Plazuelo, 41. Drawing her husband’s blood for testing took another two weeks. “We were clear that a cardiologist had to see him, he was not feeling well, and the terms were too long,” he says.


AS, 76, did not even try to get on the waiting list for cataract surgery at the León hospital. He had lost a lot of vision in a short time and decided to pay and have surgery at a private clinic in early summer. “Seeing how saturated public health was with the coronavirus, I did not want to risk it,” he says.

“I imagine that in the face of a collapse of primary care in public health, not to mention access to specialists and diagnostic tests, those who can maintain their private insurance will do so, which will not be easy because many families are being directly affected by the economic situation ”, explains Oliva. In addition, “that part of the population that does not fear for their employment will be seriously thinking about subscribing an insurance of these characteristics given the public health situation. Xavier Coller, Professor of Sociology at the Pablo de Olavide University (Seville) shares that analysis: “Those who have resources can perceive that public health is in the doldrums and they trust that private health can better serve them.

Waiting lists suffered during the crisis of the past decade and had not recovered when the pandemic struck. At the end of last year, about 705,000 people were waiting an average of 121 days for surgery, double the number in 2010. One in five patients had to wait more than half a year for surgery. During the three months that the first wave of the coronavirus lasted, hospitals suspended tens of thousands of diagnostic tests, consultations and operations, which they have been trying to recover since the summer. The Catalan Health Service estimated in October that it will take between 18 and 21 months to catch up.


The upward trend in health insurance begins to emerge in the provisional figures published by the employer. While life insurance, companies and automobiles reduced their income due to the stoppage of activity, health insurance increased 4.9% between January and September. Not even transport insurance, which includes aviation, maritime and merchandise, and has also been demanded during the pandemic, grew that much (3.58%). “Insurance is not a sector that is greatly affected by crises,” they point out in Asisa, one of the largest health insurers. “People kept their health insurance and took away other things as well. When the citizen sees a certain collapse, he gives priority to having private insurance. We have noticed it in other crises, faced with a difficulty in public health, people want to take precautions ”, they acknowledge. At Mapfre, another leader in the sector, they have observed “the increase in the demand for health insurance since June, mainly from private customers.” The insurance company SegurCaixa Adeslas reduced its income in the first half of 2020 by 13% due to the coronavirus, with falls in all insurance lines. Not so in health, which generated 6.1% more income from premiums until June.

Unespa employers recall that one of the phenomena that drives the contracting of insurance is “its growing acceptance as a payment mechanism in kind.” Many companies include health insurance as supplemental compensation. Unespa also emphasizes that those who take out a policy and use the private one ease the workload that public centers have because they do not consume those services. Oliva warns of the “high risk of dualization in health care” that began with the previous crisis: “A fast track for those who can afford access to both public and private services (via supplementary insurance) and a general highway for those who only it has an access channel ”. Not only has the situation not been reversed, but Oliva believes that “we are already installed in this model.”