Waiting lists, a structural problem of the system

Last week two facts were made public which, each on its own is very bad news, but together they are disastrous, and show that in Spain we have a very serious problem in the management of public health care: all records have been broken in patient waiting lists, while the new Minister of Health continues to try to limit the role of private health care in the health care and welfare of citizens. Worst of all, in my opinion, is that public managers seem to have no interest in making a good diagnosis of the situation, which is essential to propose an effective treatment that guarantees the quality of healthcare for the population. 

As you may have read in the media these days, we currently have the worst waiting lists in the history of Spain. More than 850,000 people are waiting to be operated on, according to data from the Ministry of Health. And to these should be added an undetermined number of citizens who are waiting for an appointment for a consultation or diagnostic test. Furthermore, if it had not been for all the regional governments sending patients to private healthcare, we could now be talking about more than 1 million citizens waiting for surgery and another million waiting for tests or consultations. A disaster. 

A careful review of the data shows that there are large differences in waiting lists, depending on the autonomous communities, as well as by speciality, which should make public and private managers reflect, adapting different strategies to the peculiarities of the territory or each process. 

I have commented several times in this blog: waiting lists have been increasing since Covid, and this fact demonstrates the seriousness of a situation that has become a structural problem of the system. Simple solutions cannot be applied to a structural problem of the system because they may contribute to worsen the situation in other areas. Unfortunately, this is what is being done, thereby aggravating the size of the health care puzzle, where fewer and fewer pieces fit together. 

That’s why, when I hear talk of crash plans, for example, my soul falls at my feet. It’s like living «groundhog day». The first time there was talk of a shock plan was in 1996, when the then councillor Joaquín Farnós launched a shock plan in the Valencian Community. That almost 30 years later we continue to call something that has become structural a shock plan is a contradiction that borders on the ridiculous. The first thing to do is to call a spade a spade, and this should be called a «structural plan for collaboration with the private sector».

I believe, much to my regret, that the situation is going to get worse in the coming years, mainly due to the social circumstances that I have also analysed in other posts on my blog: the ageing of the population, the chronicity of many illnesses, the lack of professionals… 

I want to make my opinion clear. We must increase the funding of the system, but not to do the same thing, but to introduce changes. For once, we should pool knowledge, resources and organisation and sit down in a single forum, bringing together all the players in the health sector, and draw up a common policy, in which new formulas are planned in the medium term to reduce and alleviate the problem of waiting lists, a problem that affects many citizens and many, moreover, do not have the option of turning to private health care. In this forum we should consider how to increase the capacity of universities to train more professionals, and then specialisation, as well as seeking formulas to introduce technology in the day-to-day work of patients and professionals and artificial intelligence. In short, to propose a structural reform, in which waiting lists are just one more symptom of this basic, general and organic problem. I insist: waiting lists are a symptom, they are not the problem in themselves, nor the only problem to be solved.

I believe it is time to act. It is now. All it takes is a little courage and determination. What do we have to wait for the political leaders of the autonomous communities to realise that waiting lists are not ended with temporary plans and actions at the moment, but by looking for structural solutions to structural problems? The longer it takes to diagnose a disease, the more serious it can become. And, undoubtedly, the citizen is the most affected.

And the second piece of news in recent weeks that I want to analyse in this blog entry, in the context of these terrible waiting lists, has to do with the announcement by the Minister of Health and the Government about the formulas they are considering to limit long-term collaboration with private healthcare. I have mentioned this before. Without sending patients to private hospitals, instead of 850,000 citizens on waiting lists, there would be more than one million citizens awaiting treatment. And there are still those who do not see beyond their political ideology.

At the same time, it is very surprising to hear the minister defend a supposed collaboration with the private sector in some forums. Last week, on El Español’s Wake up, Spain! she claimed that public and private healthcare, combined, are like paracetamol and ibuprofen, perfectly valid. However, he is preparing a law to limit this collaboration even further. This sort of political schizophrenia with regard to health policy already affects many agents: concessions, health concerts, Muface … In my opinion, it is a reflection of the lack of political vision on a sector that generates health, but let us not forget, also creates jobs, wealth, research and development, innovation, new technologies for well-being and much more.

That said, the drift of health policy in Spain once again demonstrates that some leaders put their ideology and prejudices before the common good, revealing their lack of vision and how little they care about the general interest of the population.

From here I would like to join other voices in the sector and call on all the agents involved to jointly tackle the major challenges facing healthcare. We have to leave behind propaganda and short-termism in something as sensitive as the health of citizens, and make more policy focused on finding solutions. Especially when the data we have on the table are increasingly catastrophic.

It cannot be that now the «solution» to the problem of waiting lists is to publish them every 6 months. As if by not providing the data, they would disappear. This is the policy of the ostrich, which hides its head in the sand because it believes that this way, the problem will disappear. Friends, what we have is an elephant in the room, a title I already used for my blog in September 2022.

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