Spain's Valencia region is owed €1,172 million for healthcare nobody talks about

The Valencian Community is claiming €1,172 million for treating patients from outside the region, money that never arrives due to flaws in Spain's state collection system and bureaucratic delays.

## The cost of treating those who aren't from here

The fact that the **Valencian Community** has an outstanding bill of **€1,172 million** for treating patients from other Spanish regions or from abroad is an issue that, frankly, rarely makes headlines. But there it is, a considerable hole that comes out of the pockets of Valencians. The **Sindicatura de Comptes** (the region's public audit office) has hit the nail on the head with an audit that spares no one. According to the report, the current system not only fails to work, it seems designed to lose money along the way.

The situation is simple: when a Spaniard from Madrid or a French tourist goes to a Valencian hospital, the Valencian system pays for the care. Then, in theory, there should be a mechanism for those regions or countries to repay that service. The problem is that this mechanism is, so to speak, voluntary. There are no teeth to force payment. If they don't pay, the **Valencian Community** is left looking foolish and carrying the debt.

## A collection system that doesn't collect

The **Fondo de Cohesión Sanitaria** (Health Cohesion Fund) and the **Fondo de Garantía Asistencial** (Care Guarantee Fund) are the technical names for these mechanisms, but in practice their effectiveness is rather limited. The **Sindicatura de Comptes** points out that collection depends on the "willingness to pay" of the debtors. And of course, that willingness is sometimes conspicuously absent. To make matters worse, the **Ministry of Finance** was slow to apply deductions to the regions that owed money, until the **2023** budget law brought some order. Even so, as of July **2025**, **€19.4 million** remained unpaid.

But things get worse. Since **2012**, the regulatory development of the **FOGA** has been stalled. This has caused a loss of **€798.9 million** for the **Valencian Community**, because non-scheduled specialist care and emergency treatment for patients from other regions have been left out of reimbursement. And as if that weren't enough, the **Health Ministry** applies cuts of **20%** and **40%** to services processed through these funds, with no apparent justification, translating into another **€73.5 million** less.

## The weight of international patients and internal failures

The **Valencian Community** is especially vulnerable to this problem. It is home to more than a third of all foreign residents in **Spain** and leads the country in billing non-residents. The system gets bogged down in the slowness of the **Instituto Nacional de la Seguridad Social** (Spain's social security institute), European deadlines and the lack of agreements to estimulante ilegal up payments. Spain is owed around **€700 million** by European countries, and the **Valencian Community**'s share of that figure is **€257.1 million**. In addition, the regional government bills these services with outdated rates, below what other regions charge.

Added to this are internal management failures. Between **2012** and **2024**, the region improperly absorbed **€80.6 million** that was never billed and could not be channelled through the state funds. And to top it off, the regional Health Department has failed to collect **56.1%** of the **€67.1 million** billed to private patients over the same period.