Juan’s phone buzzed when a message arrived informing him that the Community of Madrid was calling him to undergo an MRI at three in the morning on a Friday in mid-August. But he didn’t even consider rejecting it, remember: it’s better to have proof in hand than weeks of waiting. And he had experience of spending months without news from the hospital. Juan – not his real name – doesn’t live exactly near the Villalba Hospital where he was summoned, a center in the public network of the Community of Madrid managed by the company Quirón, but even so, the two-hour drive (round trip) was better than the alternative and accepted.
Calls for early morning tests are becoming increasingly common throughout Spain. Hospitals in Castilla-La Mancha, Castilla y León, Andalusia, Catalonia or the Basque Country have carried out this practice at least at some point in recent years with more or less regularity, both to reduce waiting lists and to further amortize the (very expensive) costs of the machines that perform certain tests, including MRIs.
“This happens more frequently in private centres, but the public system also uses these resources in the afternoon, on Saturdays and on holidays,” explains Marciano Sánchez Bayle, spokesman for the Federation of Associations for the Defence of Public Health (FADSP). “And although intensive use of the technological resources of the health system is desirable, and it does not seem to be a common phenomenon, the logic of profitability risks making it increasingly common,” he comments.
15 patients every night at Villalba Hospital
The Community of Madrid explains that in the case of the Villalba center, managed by the Quirón company, the service does not entail any additional cost for public coffers. “It is an initiative of the hospital itself, which has been going on for three years and which receives around 15 patients a day, with a very good level of satisfaction”, a statement that is difficult to contrast.
Like the following: “This is a closed and nocturnal circuit only for MRIs without contrast, and agreed with patients (except children and the elderly) for whom it is good to have these tests done at night for professional, family or other reasons”, and this service staff accompanies them from their arrival at the hospital until their departure. Precisely because this is a schedule that corresponds to this patient profile, the service has an almost non-existent absenteeism rate and very good results”, explains the spokesperson.
Juan may not consider himself “older,” but even though he remains perfectly active, he is long past retirement age. When he explains why he did not hesitate to accept this appointment, he weighs up the previous family experience: 18 months of waiting for a hernia operation. “Inside [Hospital Universitario] Infanta [Sofía, el centro que en teoría les corresponde]a year and a half. This, in two weeks. How am I going to not go to Villalba,” he reflects. If he had not accepted the appointment early in the morning, explain sources from the CCOO Health Federation of Madrid, he would have waited for a position to become available.
But it is still a matter of choosing between the bad solution and the less bad one, explains Sánchez Bayle: “The appointment time is inopportune and inconvenient because it causes great difficulties for the patient to access the center and because it alters the basic rest conditions. We believe that this is the result of a policy of maximizing profits by the private sector, which puts economic criteria before respecting patients’ rights,” continues Sánchez Bayle.
Moreover, such a schedule can turn any setback into a nightmare. In Juan’s case, he received a call from the hospital asking him to suspend the test “due to technical problems” just minutes before the appointment. “I was already in the parking lot!” the man recalls. He had made a long trip from his house in the middle of the night, so he was not willing to leave, and so he transferred it to the person who tried to convince him that they would see him again. Finally, he took the test that evening.
400,000 people waiting for consultation
Waiting lists are one of the main problems for public health managers. And in recent years, they have only grown. Although the most common statistics refer to the wait to have an operation or to see a specialist, and not to take a test recommended by the latter, the data are approximate: the average wait for surgery is now 128 days, 30% more than ten years ago, and one in four patients has to wait more than six months before undergoing surgery. Something similar happens over time until you manage to see a specialist, which already takes more than 100 days. Almost 400,000 people were waiting for a consultation, according to the latest official statistics.
To try to ease these expectations, some health officials admit, hospital opening hours are being extended, and it is no longer uncommon to be called in on a Sunday or a weekday, in the afternoon and early evening – and depending on the location, as in Quirón Villalba, more than at the beginning.
They have been doing this for some time, for example at the Regional Hospital of Malaga. Andalusia is the third autonomous community with the longest waiting list, with 24.7 patients waiting per 1,000 inhabitants. The director of the center, José Antonio Ortega, recently explained that it was necessary to “give maximum performance” to the machines that perform the MRIs, and that the waiting list was also “worrying” at the center, according to Diario Sur. But in this case, the appointments ended at 2 a.m. In Madrid, Quirón – questioned by this newspaper without response – went a step further.
Castilla y León has also put it into practice, where at least the Río Hortega and Clínico hospitals in Valladolid and the Universitario de León carry out tests until 2 a.m., also to do MRIs – always without contrast – and, in these cases, also X-rays. In Castilla-La Mancha, the University Hospital of Guadalajara has been practicing it and in Catalonia it has also been doing it for years.
These practices divide experts. On the one hand, it is appreciated that the system is more flexible and allows for greater use of public resources, especially to tackle a serious problem. On the other hand, they observe with suspicion what the exemption for patients can mean and the associations warn: “We will ensure that the refusal of these appointments does not represent a punishment for the patient”, for example by placing him at the end of the waiting list.
