OBJECTIVES: The aim of our study is to analyze the regional inequalities in the utilization and health insurance reimbursement of spa services in Hungary. METHODS: Data were derived from National Health Insurance Fund Administration (OEP), the only health care financing agency in Hungary covering the year 2007. We analyzed the annual number of treatment episodes and its health insurance reimbursement (both per 10000 population) according to the 20 Hungarian counties. We included the following type of spa treatments: spa pool of medical water, tub-bath of medical water, mud pack, medicinal weight-bath, effervescent-bath, medical health massage, sub-aquean spray massage, sub-aquean health care gymnastics for groups, complex balneotherapeutical service, health swim therapy for groups under 18. Results – both number of treatment episodes and health insurance reimbursement – are calculated for 10,000 population in each county. RESULTS: A total of 8.16 million treatments of medical spa were done in Hungary in 2007 and OEP spent 4,434 billion HUF (Hungarian Forint) [US$25,687,967] for financing these interventions. The national average of treatment episodes was 8033 per 10000 population while the average OEP reimbursement was 4,365 million HUF per 10,000 population. The detailed analysis of counties resulted in high geographical differences. We found the highest number of utilization in county Csongrad (treatment episodes: 15,193; reimbursement: 7,647 million HUF), in county Hajdu-Bihar (treatment episodes: 11,687; reimbursement: 7,193 million HUF) and in Budapest (treatment episodes: 10,625; reimbursement: 5904 million HUF). The lowest utilization of spa services can be found in county Szabolcs-Szatmár-Bereg (treatment episodes: 4107, reimbursement: 1999 million HUF) and Nograd county (treatment episodes: 4782, reimbursement: 2497 million HUF) and Borsod-Abauj-Zemplen county (treatment episodes: 4891, reimbursement: 2596 million HUF). CONCLUSIONS: Our study revealed more than 3 times higher difference both in the utilization and health insurance reimbursement of spa services between counties in Hungary.