The socialist government of José Luis Rodríguez Zapatero guaranteed, through a royal decree approved in 2011, that no citizen would wait more than six months (180 days) for a hip or knee replacement, cataract surgery or heart surgery. This was signed by Leire Pajín, then Minister of Health. But a decade later, communities are not respecting these guarantees and delays are not being penalized either. It was never envisaged in the standard that this would be the case.
“That’s the problem, maybe it’s a little inconvenient, but nothing more,” says José Ramón Repullo, an expert in health planning and health economics. The Ministry of Health announced a few months ago that it was going to change the way it measures delays, because it does not give a true picture of the situation. As part of these changes, assures a Health spokesperson interviewed by this media, the royal decree which sets the limits could also be revised. Decisions will be made based on the conclusions of a working group on waiting lists which is “starting to function”, specifies Santé.
The most extreme situation occurs in Extremadura, where almost half of the patients waiting for knee surgery exceed the threshold set by the standard. The average waiting time is 213 days. Hip replacements in the same region also take longer than necessary for 40% of patients on the list, even though not all communities – none are spared – comply with this procedure, data analysis shows produced by elDiario. .es based on official statistics offered by the Ministry of Health twice a year.
If we look at the knee replacement, Extremadura is not the only one that stands out badly in the photo. Andalusia, Aragon and Cantabria keep a third of people requiring this intervention waiting for more than six months. In contrast, Madrid, with a wait of 47 days and practically all patients operated on during this period. In the search engine above you can check the situation in each autonomous community for the five interventions with guaranteed waiting: cataract, knee replacement, hip replacement, coronary surgery (bypass) and heart valve surgery.
There is only one intervention with which all communities, even if they are more or less behind, achieve the objective: the bypass in the heart. This is an operation to restore blood flow to a blocked artery. No one in Spain waits more than six months to need this intervention, although there are big differences in the legal margin between the three days on average provided in Euskadi and the 104 in Cantabria. But this is an exception.
In the case where the operation involves installing a valve, the situation gets worse: one in four people in Castile-La Mancha and Extremadura who are prescribed the operation have to wait more than six months. The Ministry of Health warned in a press release reporting the latest data on waiting lists: “There is a slight deviation from the objective of 2.7%”, or almost 3% of Patients who require this surgery wait more than 180 days.
Here’s how the wait of more than three months varied in each community
Half-yearly evolution of the percentage of patients waiting for an operation for more than 180 days, by community and surgical specialty
Source: Ministry of Health
In cataract – formed when an area of the lens becomes cloudy – 6.6% of patients nationwide spend more than 180 days on the list, although in reality they accumulate mainly in two communities that get poor note: Castilla – La Mancha (26%) and Aragon (20%). Hips and knees have a much longer wait per territory and per patient concerned: 15% of candidates for surgery in Spain exceed the legal limit in the first case; in the second, it is worse, almost one in four (23%), according to Health.
Experts question the effectiveness of this model but also the way in which it was implemented ten years ago. “The system is a bit crazy because it’s not so much the moment that matters but the state in which the person finds themselves. The impact of cataracts is not the same if you are a bus driver or something else,” explains Salvador Peiró, specialist in preventive medicine and public health. “Now,” he then adds, “no community likes to be in the picture.” “We need to resolve the structural and budgetary problems of the national health system and play less with implausible sanctions,” says Repullo.
