MADRID (AP) — Spaniards spent a record high amount on private health insurance last year, according to data released Wednesday, amid growing discontent with the country’s once-prized public health system.

Spending in 2022 hit a total $11.36 billion, an increase of 7% over 2021, Spain’s Association of Insurers said. It added that around 12 million Spaniards — a quarter of the population — are now covered by a private health policy.

The figure is all the more remarkable as all working Spaniards must contribute payments for public health insurance — while public health care is available free of charge to the registered unemployed.

Poll data from Spain’s CIS public research institute late last year show that just 11% of Spaniards think the public health system “generally functions well.”

Waiting times for appointments with physicians have doubled across Spain since the COVID-19 pandemic began, while almost 40% waited more than three months to see a specialist.

In Madrid, the capital, doctors have held a series of strikes in recent months over pay and working conditions.

Doctors’ unions say Madrid spends the least amount per capita on primary health care of any Spanish region, even though it has the highest per capita income. They claim that for every 2 euros spent on health care in Madrid, one ends up in the private sector.

Healthcare in Spain is devolved to its 17 regional governments.

The World Health Organization warned last year that all European nations “currently face severe challenges related to the health and care workforce.”