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HEALTH

Where in Spain is primary healthcare most overburdened?

Two years into the pandemic and the consequences have had a serious effect on primary healthcare in Spain. Staff shortages, spending cuts and long waiting times have all contributed to this, but which regions have it worse?

Waiting to see the doctor
Where is healthcare the worst in Spain? Photo: Saeed KHAN / AFP

Spain has one of the best public healthcare systems in the world, but that doesn’t mean it’s perfect. 

Findings from Spanish Federation for the Defence of Public Health (FDASP) published on April 12th 2022 show that Spain’s regional public healthcare systems have “very serious” underfunding problems, “intolerable” delays in appointments and huge inequalities between communities, with some in a “critical” situation.  

The report reveals that the primary health care situation in Madrid is the worst, closely followed by the Balearic Islands and then Catalonia.

According to the FDASP although the Balearics and Catalonia have made “an effort to improve, at the moment they continue to be in a very bad situation”.

Why is the healthcare situation so bad?

The first year of the Covid-19 pandemic resulted in an increase in the number of people applying for individual health cards per family doctor and nurse, and a decrease in the number of pediatricians and administrative professionals.

The national ratio of public health cards per GP is 1,345, three more than in 2019, although they range between 909 in Castilla y León to 1,538 in Madrid.

READ ALSO: How to apply for a public health card in Spain

The FDASP report described the situation in Madrid as “hardly tolerable” and even “scandalous” with 47.5 percent of medical professionals assigned between 1,500 and 2,000 patients and 6.07 percent above that figure.

In the Balearic Islands, the problem is in fact even worse where these figures skyrocket to 74.2 percent and 9.5 percent, respectively. 

Waiting times for appointments

Waiting times for appointments are also particularly worrying. In Spain on average, 41.5 percent were able to receive care after 48 hours and 34.7 percent in seven or more days.  

The waiting time situation in Catalonia and Valencia is particularly bad. In Catalonia, 77.7 percent received care after 48 hours and 57.3 percent after seven or more days, while in Valencia 87.3 percent were seen after 48 hours and 41.5 percent had to wait seven or more days.

Throughout Spain, the majority of the population, 69.6 percent, were unhappy with the delays and 27.7 percent said they had to wait more than an hour to be seen after arriving at the healthcare centre.

READ ALSO: Pandemic forces Spain’s hospitals to cancel 570,000 surgeries

Which regions have the most underfunded health care systems?

According to the FDASP, Madrid is the most underfunded health care system in Spain and the one that spends the least amount per inhabitant. They also intend to allocate even less funding to public healthcare in 2022.

The FADSP said that spending on primary care “remains low” across all regions, since the percentage with respect to total public health spending is still below that of 2010. 

The latest data available for healthcare budgets from 2019 shows that an average of 14.16 percent was spent on public health, a figure which was 0.24 points higher than that of 2018, but still 0.74 points lower than that of 2010. The growth occurred in all the communities except Castilla-La Mancha, Madrid and Asturias.

The regions that spent the least amount on healthcare were the Balearic Islands and Madrid (11.21 percent), Asturias (11.95 percent) and Galicia (11.96 percent). While regions that spent the most were Andalusia (18.01 percent), Extremadura (16.16 percent) and the Valencian Community (15.09 percent). 

There was also a small increase in spending per inhabitant of €4.28, an increase that occurred in almost all the communities except Asturias, the Balearic Islands, the Canary Islands and Castilla-La Mancha.

A total of 10 regions exceeded the average: Extremadura (€272.48); Basque Country (€267.84); Castilla y León (€262.45); Navarre (€250.71); Cantabria (€230.18); Murcia (€229.32); Andalusia (€227.16); Valencian Community (€223.03); Aragón (€214.66) and La Rioja (€217.97). 

The others differ wildly, particularly Madrid which only spends €150.08 per inhabitant, which is 60.93 less than the previous year. While the Balearic Islands spent €174.05 and Galicia spends €188.16, differences that “inevitably” lead to “great inequalities in primary care benefits”, the report suggested.

Healthcare was already “severely weakened” by the cuts and the health crisis has only “aggravated matters and brought it to a critical situation,” concluded FADSP spokesman, Marciano Sanchez-Bayle.

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TERRORISM

Spain sees heightened terror risk amid global conflicts

Amid rising tensions and conflicts in Ukraine, Gaza and elsewhere around the world, a meeting by Spain's National Security Council has identified several threats to national security, some pre-existing and some new.

Spain sees heightened terror risk amid global conflicts

Global conflict and instability has raised the terror and security risk in Spain. This is what Spain’s National Security Council (CSN) has concluded following a meeting with government ministers on Tuesday to approve security reports and outline new anti-terror strategies. A 61-page document was compiled to replace the previous one approved in 2019 and will be valid for five years.

Among the topics discussed, which are outlined here on the National Security Council website, were the ongoing conflicts in Gaza and Ukraine and the heightened security threats they pose to Spain.

The war in Gaza, the Council states, presents “a real and direct risk” of an increase in “the terrorist threat, violent extremism and the emergence of new movements that promote a radical and violent ideology.”

READ ALSO: Spain could enforce conscription of ordinary citizens if there is war

Russia’s invasion of Ukraine, the document stresses, is also “a potential catalyst for terrorism”, as it “has led to an increase in the circulation of arms and explosives [in Europe], as well as the participation in the war of volunteer fighters of other nationalities”.

These uncertain global conditions could be exploited by groups or individuals “to undermine public security”, the document adds, and suggests that “state actors could carry out terrorist actions,” in what appears to be an allusion to the assassination of a Russian soldier in Alicante earlier in the year.

READ ALSO: Mystery surrounds death of Russian helicopter deserter in Spain

The meeting and report also outlined broader “risks and threats to national security” grouped into 16 categories, some older and long-established, some much more modern. They range from terrorism and violent radicalisation to the effects of climate change, space vulnerability, cyberspace, organised crime, migratory flows, foreign espionage and interference from abroad.

The CSN detects growing dangers to Spanish airspace, namely “events of commercial satellite launches from aerial platforms crossing controlled airspace, events of re-entry into the Earth’s atmosphere of satellite launcher debris, uncontrolled hot air balloon overflights and an increase in drone overflights over military bases,” things that have all been noted in Spain in recent years.

In terms of terrorism, despite the conflicts in Gaza and Ukraine Islamic terrorism remains the greatest threat to Spanish security. “The repeated dismantling of the leaderships of Daesh and Al Qaeda has not succeeded in eliminating these groups, which act in a more decentralised manner than in previous years,” the report states.

During the period covered by the previous security strategy (2019-2023) “more than 110 [security] operations related to terrorism activities have been carried out,” more than 90 of which were linked to jihadist terrorism, the document details. Just 5 percent were linked to domestic terrorism.

Foreign spies operating in Spain were also highlighted as a threat. The CSN report stated that the decision to expel 27 Russian diplomats from Spain at the beginning of the full-scale invasion of Ukraine in 2022 was useful in this regard. “These expulsions significantly reduced their ability to operate on European territory, which led to a notable decrease in the rate of activity of foreign intelligence services in Spain,” the report states.

READ ALSO: Judge in Spain extends probe into Catalan separatist’s ‘Russia ties’

However, the potential threat from the Kremlin is again mentioned as the driving force behind the barrage of hoaxes and disinformation campaigns. In the case of Spain, Moscow reportedly “focuses on trying to spread a distorted image of migration in the Mediterranean and the situation in Ceuta and Melilla”.

But it’s not just the Russians attempting to misinform the public in Spain. The report also points to “official Chinese media and their propagandists on social networks in Spanish have amplified many pro-Russian narratives”, with messages “based on expressing a rejection of the US and the current international order”.

The report lists 83 Russian disinformation incidents and 12 Chinese in the last year alone. Among these, several were aimed at “creating mistrust” in Spain’s electoral processes.

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