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The “Spain: Health System Review 2024,” published by the European Observatory for Health Systems and Policies, provides a comprehensive analysis of Spain’s decentralised national health system, known as the Sistema Nacional de Salud (SNS). The SNS offers nearly universal coverage, funded primarily through taxes, with healthcare services delivered predominantly within the public sector, free of charge at the point of care. Recent reforms aim to strengthen universality, equity, and cohesion, especially for vulnerable populations, while addressing challenges such as access gaps and workforce shortages. The review highlights Spain’s strong health outcomes, though areas such as mental health, dental care, and efficiency improvements remain priorities for the future sustainability of the system.