Spain’s public health care system has not recovered from the pandemic. This is an effect of two systemic problems: the hard hit to the system brought on by the pandemic and its management.
The latest figures from the Ministry of Health show that patient wait times for primary care visits, specialist appointments, and surgery all continue to lengthen.
“We have not been able to get back to the numbers we had before the COVID pandemic,” says Marciano Sánchez-Bayle, president of the Spanish Association for the Defence of Public Health.
Even before the pandemic upset the normal operations of the Spanish health system, every Spaniard knew someone who suffered for months with a common condition waiting to see a specialist, had to wait to undergo routine tests, or was placed on standby to get a follow up appointment.
Euronews tells the story of a 90-year woman who went to the emergency room, was diagnosed with a stroke, and has been waiting eleven months for a CAT scan.
Another patient went to his GP, who sent him directly to the emergency room for an irregular heartbeat. The man was stabilized in the emergency room but had to wait two months to see a cardiologist and eight months for common cardiac ablation surgery (a procedure used to correct heart rhythm problems).
The process from the initial onset of symptoms to the curative treatment inevitably lasts long. Patients have to wait weeks or months between appointments, tests, and follow-up appointments before even being put on the waiting list for surgery.
Government figures show that Spaniards were waiting an average of 95 days, nearly three months, for an appointment with a specialist. The average wait time for surgery is four months with 20% of patients waiting more than six months, up from 17% six months ago.
Spain’s aging population tends to have ailments with the longest waiting time.
“As is habitual,” the report states, orthopaedic and eye surgeries have the lengthiest waiting times. Knee replacement surgery takes the longest to get, averaging 141 days. For the elderly, who are more prone to suffering strokes, seeing a neurologist takes an average of 113 days, also one of the longest wait times.
According to Sánchez-Bayle, the problems are both systemic and a result of the pandemic.
Funding for the public health care system was cut by 20% as an austerity measure during the financial crisis of 2008, and it has not substantially increased since then, according to Sánchez-Bayle. Compared with its neighbours, Spain invests far less in health care for its citizens.
It invests approximately €1,808 per capita, while the EU average is €2,244. Germany spends €4,418 per capita, compared to France’s €3,523 and Italy’s €2,043.
Then, during the pandemic, treatment of most patients not suffering from COVID-19 was put on hold. Spaniards had the feeling that doctors had “entrenched” themselves in their offices and hospitals and were keeping patients at arms length. Telephone appointments replaced most in-person appointments and patients were sometimes simply asked to postpone treatment.
Treating the backlog of medical needs started in 2021, but according to Sánchez-Bayle, 20,000 fewer surgeries were carried out in 2022 than in 2021.
Even in primary care, which has usually been considered a strong point of the Spanish health care system, the average wait for an appointment increased from eight to nine days between 2021 and 2022, while fewer primary care appointments were made. According to Sánchez-Bayle, patients should have to wait no more than 48 hours to see their primary care doctor in 90% of the cases.
The longer waits are leading patients to find other solutions, in the meantime, and not showing up for primary care appointments, according to Sánchez-Bayle, who adds that this is a new phenomenon in Spain.
He also blames the long wait times on a lack of coordination between primary care and specialty departments, and a very limited number of hours for both specialty consultations and surgery.
In many clinics, primary care doctors see clients up to twelve hours a day. But specialty appointments and surgeries are only offered during the Spanish “morning” from 8 or 9 a.m. until 2 or 3 p.m. Only emergency rooms operate on the weekends.
Besides calling for funding to fix the “structural, chronic deficit of nurses, midwives, and physical therapists,” the Spanish nurse’s union has also submitted a list of 50 recommendations to both politicians and administrators that mirror Sánchez-Bayle’s point of view. The most important are basic and politically uncontroversial, including expanding clinic and operating room hours, allowing nurses to handle the coordination of follow-ups and testing for already diagnosed conditions, and improving interoperability of medical records and other digital operating systems to make the system more agile and functional.
Why are so many seemingly easy improvements to the administration being neglected?
“On the one hand, these measures require changes in the planning and organization of human and material resources that each administration has.” The nurses’ union told The European Conservative:
They don’t want to perform them because it is easier to maintain the situation as it stands today. It requires effort, dedication and time they do not want to put forth. They prefer to adopt specific short-term measures that, as we say, are less demanding.
The nurse’s union has also been pushing for a law to establish required minimum staffing levels.
But the trade magazine Redacción Medica reports that an analysis of a similar law, which has been implemented in Germany since 2019, did not improve the health system. In an independent report, the consultancy KPMG concluded that “the German experience in the application of laws similar to the nursing ratios law did not give the expected results.”
The report pointed out that the problems were multiple, including not being able to meet the markers because the labor market lacked the required number of professionals. The legal ratio of professionals could not be met, which led to a reduction in intensive care unit beds. The study cited a 2020 survey that found 29 percent of hospitals were in favor of cancelling without replacing the law, and 63 percent wanted replace the lower limits with another measurement method.
