Using European Commission funding, the Spanish government has increased the number of positron emission tomography (PET) scanners across Spain. These funds were allocated to improve the resilience and sustainability of health systems in the wake of the COVID-19 pandemic. The systematic collection and presentation of data, complemented by strong advocacy efforts by medical societies, were the key factors in making PET scanners a policy priority.


Inadequate access to PET scanners in some regions of Spain had a negative impact on care. The large machines are a standard of care, using a radiopharmaceutical to diagnose, image and predict the disease course of many different cancers, as well as Alzheimer’s disease and heart disease. In 2013, some regions of Spain had as many as 3.11 scanners per one million inhabitants while some had as few as 0.48.1 This regional discrepancy meant that people in some areas of the country did not have access to appropriate care. Action was not being taken to change this; there was only a 3% increase in the number of PET scanners nationally between 2013 and 2021.1 2

In late 2020, a report was published by RPP Group highlighting the need for preparedness for radioligand therapy in Spain.3 This report was informed by a review, published by the Independent Authority for Fiscal Responsibility (Autoridad Independiente de Responsabilidad Fiscal), of the age of medical equipment, including PET scanners.4 Both review and report called for improved infrastructure across the health system, especially when it came to the age and distribution of scanners. The data from these two publications, as well as guidance on how to collect and present data in a compelling way, were used by medical societies to continually advocate for the implementation of new PET scanners.5

At the same time both the review and the report were published, Spain was approved for funding for ‘high-tech equipment for the national health system’.6 The funding was allocated as part of the European Commission’s Recovery and Resilience Facility (RRF), with the aim of enabling Member States to implement reforms and investments to improve resilience and sustainability.7 To understand how best to distribute the funding, the Spanish government conducted iterative in-depth consultations with various medical societies, including the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM), as well as gathering the ‘needs’ of the health system from regional governments.5

What has been achieved?

Consistent advocacy backed up by strong data in the reports helped to ensure PET scanners were a policy priority to help improve resilience and sustainability in the Spanish health system. Following consultation, the Spanish government approved the spending in mid-2021, moving to both refurbish existing PET scanners and procure new scanners. This action was a part of Plan INVEAT, the scheme for investment in high-tech equipment across the national health system.8 As of May 2023, the number of PET scanners across Spain had increased from 84 to 103, a 22.6% increase.9

However, the allocated RRF funding does not cover all costs. Maintenance, training and further new infrastructure must be financed by regional governments, which may be a barrier to usage. Funding for PET infrastructure is just one piece of the puzzle, so securing further funding and support for the other components of the system is an essential next step.

Future relevance

Within Spain, the existing data can support regional advocacy efforts to obtain funding for training, maintenance and long-term usage of the PET scanners.

This work has demonstrated that data-driven stakeholder advocacy can be critical to getting PET scanners and other infrastructure on the policy agenda. While the funding situation was unique to Spain, the takeaway lesson is broadly applicable to other countries: any stakeholder groups which aim to engage policymakers need to ensure they have a systematic way to collect and present data.

  1. Soriano CA, Prats RE, Alonso FJ, et al. 2014. Medicina nuclear en España: alta tecnología 2013. Revista Española de Medicina Nuclear e Imagen Molecular, 33(6)
  2. OECD. 2021. Health at a Glance 2021: OECD indicators, Diagnostic technologies. Available from: [Accessed 30/06/2023]
  3. Martínez Olmos J, Cervera Taulet M, Rodriguez-Lescure Á, et al. 2020. Terapias dirigidas con radioligandos en oncología. Madrid, Spain: RPP Group
  4. Autoridad Independiente de Responsabilidad Fiscal. 2020. Gasto hospitalario del sistema nacional de salud: famacia e inversión en bienes de equipo. Madrid, Spain: Autoridad Independiente de Responsabilidad Fiscal
  5. Domingo A. 2023. Interview with Lucy Morgan and Emily Medhurst at The Health Policy Partnership. 05/04/23
  6. European Commission. 2021. High-tech equipment for the national health system (INVEAT). Available from: [Accessed 01/06/23]
  7. European Commission. 2021. The Recovery and Resilience Facility. Available from: [Accessed 01/06/23]
  8. Minsterio de Sanidad. 2021. Plan INVEAT: Inversión en Equipos de Alta Tecnología. Madrid, Spain: Minsterio de Sanidad
  9. Marcio Rodrigues. 2022. Interview with Lucy Morgan and Jessica Hooper at The Health Policy Partnership. 07/10/22