How much does Spain invest in public oral health care? A regional minimum estimate

Background

Spain has expanded its National Health System oral health benefit package, but public oral health financing remains poorly visible across autonomous communities. Dental care contributes substantially to catastrophic out-of-pocket payments, requiring analysis of investment underlying service provision.

Aim

To estimate minimum traceable public oral health investment by autonomous community and describe regional inequalities.

Methods

Cross-sectional health financing analysis of 17 autonomous communities and two autonomous cities. The main lower-bound estimate included public dentists/stomatologists, dental hygienists, oral and maxillofacial surgeons (OMFS), plus traceable PADI-type or concerted externalisation. Workforce costs came from regional salary tables; externalised expenditure from transparency requests and budgets. Per-capita investment used INE 2024 population. Sensitivity analysis excluded OMFS to approximate primary/community dental care investment.

Results

Including OMFS, minimum investment was €185.3 million/year (€3.81/inhabitant/year; ∼0.18% of public health expenditure). Regional estimates ranged from €2.47/inhabitant/year in the Valencian Community to €7.11 in Melilla. Reaching the national mean in below-average regions would require €19.8 million/year. Andalusia showed the largest residual gap, after including PADI/externalised expenditure and partly due to population size. The Valencian Community had the lowest per-capita investment and the largest deficit among public-only regions. Excluding OMFS, the estimate fell to €163.3 million/year; inequalities persisted.

Conclusions

Minimum public oral health investment appears limited, unevenly distributed and conditioned by regional provision models. These findings should be interpreted alongside evidence on catastrophic out-of-pocket dental payments, supporting integrated monitoring of public financing, household financial protection and implementation of the expanded benefit package.

Key messages

• Minimum traceable public oral health investment in Spain is estimated at €185.3 million/year (€3.81/inhabitant/year), representing approximately 0.18% of total public health expenditure.

• Regional per-capita investment ranges from €2.47 (Valencian Community) to €7.11 (Melilla), revealing marked territorial inequalities in public oral health financing across autonomous communities.