One of the things that holds you back the most is blindness. How many times have we heard, from the mouth of a politician, that our healthcare system – public, universal and free – was an example for the rest of the world? Very often, for sure. Well ! know it, it is no longer true.
Evoking a glorious past does not change the current situation: as of December 31, according to the Spanish Ministry of Health, 706,740 patients were on the waiting list for surgery. And that without counting the prior waiting lists to enter the final list in order to undergo examinations or access a consultation with a specialist.
More than 140,000 people are waiting more than six months for life-saving operations. “The worst number in twenty years that we have kept this register, highlights Juan Abarca, president of the Institute for Health Development and Integration. The eternal waiting list has become the norm without realizing it, but it is nonetheless a sign of the poverty in which our National Health System (SNS) finds itself.”
“Although there are significant differences between autonomous regions [compétentes en matière de santé publique]the problem of waiting lists is national, structural and very old, explains Ignacio Riesgo, health expert with the consulting firm Roland Berger. Such situations are more frequent in countries that have an SNS type system. – without co-payments or with low co-payments and capacity limitations. However, they are not linked to public systems of universal access. Many countries have this system and do not have problems with waiting lists, such as Switzerland, Germany, France, Belgium or Japan.”
Un “stress constant” post-Covid
Experts and analysts agree that the pandemic has left the Spanish SNS bloodless, bringing it to a point of no return. The only solution to save it is to take decisions from above, emanating from political power.
“We leave behind a constant state of stress due to the pandemic. This crisis has required improvised decisions that have destabilized our healthcare system”, adds Rafael Bengoa, former Minister of Health and Consumer Affairs of the Basque Autonomous Government and former Director of Health Systems at the World Health Organization (WHO). “The worst, he continues, it is the possible exodus of health professionals to the private sector, even if I believe that we still have time and a lot of will to stabilize the system.”
This former advisor to US President Obama on health confirms that it is the public system that saved our country from the greatest crisis in its recent history. He believes that the current challenge goes beyond ideological questions. Without investment, services will continue to deteriorate.
He takes an example: “We are ineffective in managing patients with chronic diseases. If a diabetic comes to the emergency room in Spain, it’s because we haven’t done things the way we should have. Primary care, home assistance and health education must be strengthened. If this is done, patients will no longer have a reason to overcrowd the emergency room, which is by far the most expensive element of the system.”
Call for patient mobilization
For ten years, all the projects implemented to reduce waiting lists have this in common that none has worked. Juan Abarca calls for the mobilization of all. “I hope there will be a sling of the patients, he throws, that they will take to the streets to defend our most precious asset as a society, without which social cohesion is not possible. It may be the only way.”
It also recalls the failure of a royal decree of 2011, which set the criteria for guaranteeing maximum access time to health services from the SNS, so that, for the most frequent pathologies, effective solutions can be found for from 180 days. “We left it there, the decree was never applied”, laments Abarca.
In fact, this is one of the avenues favored by the Consensus for a 21st century health system.e century, drawn up in 2020 by an independent working group, under the direction of Ignacio Riesgo. This document proposes other solutions to put an end to the scourge of waiting lists: an agreement on inclusion criteria – concluded with the country’s scientific societies –, the establishment of incentives for the public system, the accreditation of private centers related to the different types of activities, which, once the waiting period has passed, could take charge of the patient.
A reform in the waiting room
But we will not progress on this issue without listening to health professionals. Tomás Cobo, president of the Collegiate Medical Organization (OMC), explained recently – as part of one of the many delegations of the profession before the Spanish Congress of Deputies – the main reason for the stalling:
“The Ministry of Health must intervene, it cannot remain a mere spectator. It’s a consistency problem, there are 17 health services in Spain [un par région autonome]and the government has a responsibility to be in the driver’s seat.”
The Spanish Ministry of Health is currently preparing a draft law of measures for the equity, universality and cohesion of the National Health System. This will be an opportunity to tackle the problems.