Spain is home to well-established and heavily regulated pharmaceutical and biotechnological industries, concentrated primarily in the capital city of Madrid and the eastern autonomous community of Catalonia. While Madrid has hosted many of the world’s multinational pharmaceutical giants for years—including Novartis, GlaxoSmithKline, Roche, Sanofi, and AstraZeneca—the country’s northeastern region has fostered the development of Spanish multinational players such as Esteve, Almirall, Ferrer, and Grifols. Today, Spain is the fifth largest European pharmaceutical market, with the sector accounting for 1.4% of the country’s total GDP. The industry’s longstanding relevance parallels the country’s world renowned National Health System, which consistently ranks highly among its peers. In 2014, Bloomberg ranked Spain as the world’s 14th most efficient health care system, far ahead of the United States and Canada.

Since the economic crisis of 2008, however, Spain’s expenditure on healthcare has progressively declined, placing the nation well behind its fellow OECD countries. Prior to the economic crisis, Spain was a leader in healthcare investment, spending up to €64.3 billion in the sector in 2009, compared with €53.5 billion in 2014. Furthermore, spending cuts have not been consistent across the country, creating causes for concern over the rise of regional inequities. The Spanish government has implemented a series of cost-saving measures, presenting financial concerns to the industry at large.