Specialised advisory for healthcare companies in Spain

Spain’s healthcare sector comprises more than 163,833 active companies and employs approximately 1,338,891 workers registered with Social Security, making it one of the structural pillars of the national economy. With aggregate revenues exceeding €39.4 billion and a gross margin of 21.8%, the sector combines sustained demand with growing regulatory pressure: consolidation of the private clinic segment through mergers and acquisitions, the emergence of biotech and molecular diagnostics companies, the rise of telemedicine and the changes introduced by the new European Medical Device Regulation are reshaping a competitive landscape at speed. At the same time, NHS pricing and reimbursement rules, clinical trial regulation and health data privacy obligations create a compliance burden that no organisation can face without specialist advisory.

At BMC we accompany pharmaceutical laboratories, biotech and diagnostics companies, medical device manufacturers, private clinics and hospital groups across their tax, legal and corporate advisory needs. Our services include structuring corporate transactions in the sector — mergers, acquisitions, joint ventures — specialist due diligence on healthcare assets, R&D tax planning and comprehensive grant management for biomedical research projects with the CDTI, the Instituto de Salud Carlos III and Horizon Europe.

Intellectual property protection — pharmaceutical patents, supplementary protection certificates, data exclusivity — is a critical area where we combine legal and tax advisory to maximise the value of intangible assets. We assist groups with centralised R&D in documenting transfer pricing policies and applying the Spanish Patent Box regime, and we help organisations across the sector comply with health data protection rules — GDPR applied to medical records and biometric data — and structure their licence and technology transfer agreements with Spanish universities and research centres on sound legal footing.

The broad business fabric of the sector — 163,833 companies, ranging from large hospital groups to single-site diagnostic centres — coexists with considerable variation in management maturity. At BMC we work with both listed groups requiring sophisticated corporate advisory and independent clinics seeking to optimise their tax and employment structure, secure regulatory compliance and grow in an orderly manner. The depth of our team’s sector knowledge means we anticipate problems before they become liabilities.

Key services for healthcare operators

Tax planning for private healthcare providers requires analysis of the VAT exemption applicable to medical services (article 20.One.3 of Spain’s VAT Law). The exemption applies to diagnosis, prevention, treatment, rehabilitation and palliative care services — but not to ancillary services such as catering, parking or non-medical accommodation, which are subject to the standard VAT rate. Correctly delineating exempt and taxable activities in complex hospital environments requires case-by-case analysis.

Due diligence in healthcare M&A requires specific scrutiny of regulatory licences and authorisations, healthcare professional employment contracts and collective agreements, patient liability exposure, concerted healthcare agreements with regional health authorities, supply chain contracts, and goodwill treatment in healthcare valuations. We coordinate multi-disciplinary teams to deliver comprehensive healthcare due diligence within transaction timescales.

Data protection in healthcare presents the highest risk profile under the GDPR. Health data is a special category under Article 9, requiring an explicit legal basis for processing. The digitalisation of healthcare — electronic health records, telemedicine platforms, AI-assisted diagnostics — creates a continuously expanding data protection compliance obligation. We advise healthcare providers on GDPR compliance programmes, data processing impact assessments and AI Act obligations for high-risk medical AI systems.

Regulatory challenges for healthcare in Spain

ESG reporting is increasingly relevant for healthcare groups. Private equity investors and infrastructure funds investing in private healthcare value a robust ESG framework as an investment and due diligence criterion. The social dimension of ESG — access to healthcare, treatment outcomes, employee wellbeing — is particularly significant in the healthcare sector and must be reported under CSRD standards from 2026 for large healthcare groups.

Concerted healthcare arrangements (conciertos sanitarios) between private providers and regional health authorities are complex contractual relationships governed by public procurement law, with specific fee schedules, quality standards and volume commitments. The negotiation and management of these concerted arrangements — and the management of disputes with health authorities — requires specialist legal and financial advisory combining healthcare sector knowledge with public administration law expertise.

KPIs and trends for healthcare in Spain 2025-2026

Spain’s private healthcare sector encompasses 467 private hospitals and clinics, 17,000 private medical practices and more than 200,000 healthcare professionals working in the private sector. Private health insurance coverage reached 12.5 million policies in 2024, growing 4% year-on-year, driven by waiting time pressures in the public system. Private equity consolidation of hospital groups, diagnostic laboratory chains and dental networks is driving significant M&A activity, with transaction multiples of 8-12x EBITDA for market-leading platforms.

Key services for healthcare operators

Tax planning for private healthcare providers requires analysis of the VAT exemption applicable to medical services (article 20.One.3 of Spain’s VAT Law). The exemption applies to diagnosis, prevention, treatment, rehabilitation and palliative care services — but not to ancillary services such as catering, parking or non-medical accommodation, which are subject to the standard VAT rate. Correctly delineating exempt and taxable activities in complex hospital environments requires case-by-case analysis.

Due diligence in healthcare M&A requires specific scrutiny of regulatory licences and authorisations, healthcare professional employment contracts and collective agreements, patient liability exposure, concerted healthcare agreements with regional health authorities, supply chain contracts, and goodwill treatment in healthcare valuations. We coordinate multi-disciplinary teams to deliver comprehensive healthcare due diligence within transaction timescales.

Data protection in healthcare presents the highest risk profile under the GDPR. Health data is a special category under Article 9, requiring an explicit legal basis for processing. The digitalisation of healthcare — electronic health records, telemedicine platforms, AI-assisted diagnostics — creates a continuously expanding data protection compliance obligation. We advise healthcare providers on GDPR compliance programmes, data processing impact assessments and AI Act obligations for high-risk medical AI systems.

Regulatory challenges for healthcare in Spain

ESG reporting is increasingly relevant for healthcare groups. Private equity investors and infrastructure funds investing in private healthcare value a robust ESG framework as an investment and due diligence criterion. The social dimension of ESG — access to healthcare, treatment outcomes, employee wellbeing — is particularly significant in the healthcare sector and must be reported under CSRD standards from 2026 for large healthcare groups.

Concerted healthcare arrangements (conciertos sanitarios) between private providers and regional health authorities are complex contractual relationships governed by public procurement law, with specific fee schedules, quality standards and volume commitments. The negotiation and management of these concerted arrangements — and the management of disputes with health authorities — requires specialist legal and financial advisory combining healthcare sector knowledge with public administration law expertise.

KPIs and trends for healthcare in Spain 2025-2026

Spain’s private healthcare sector encompasses 467 private hospitals and clinics, 17,000 private medical practices and more than 200,000 healthcare professionals working in the private sector. Private health insurance coverage reached 12.5 million policies in 2024, growing 4% year-on-year, driven by waiting time pressures in the public system. Private equity consolidation of hospital groups, diagnostic laboratory chains and dental networks is driving significant M&A activity, with transaction multiples of 8-12x EBITDA for market-leading platforms.