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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?

Published: 13 April 2022 15:04 CEST
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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SPANISH LAW

Ley ELA: What is Spain’s new neurodegenerative disorders law?

Spain's new 'ALS Law' has been expanded to include all other neurodegenerative disorders such as Alzheimer's, Parkinson's and Huntington's. Here's what you need to know.

Published: 29 April 2024 10:24 CEST
Ley ELA: What is Spain's new neurodegenerative disorders law?

What is Spain’s ELA law?

La ley de ELA (ELA law) was initially created for (and named after) people suffering with Amyotrophic Lateral Sclerosis – a degenerative illness that affects around 4000 Spaniards.

The law has seen several iterations in recent months and drafts have been presented by different parties with different alterations and amendments.

It was originally put forward by the centre-right opposition Partido Popular to modify 2006 legislation on Personal Autonomy and Care for dependent persons, and included a specific set of changes for patients diagnosed with ALS, with the underlying aim of speeding up diagnosis and increasing benefits for care.

Why is legislation needed?

In Spain, it is estimated that there are over 1 million people and families affected by a neurodegenerative disease. Due to the characteristics of these disorders and the changing (namely ageing) demographics of Spanish society, their prevalence is increasing. Many struggle to get the appropriate care they need in a timely manner.

The ELA law aims to speed up these processes and better coordinate care between health and social services.

READ ALSO: Older and more diverse: What Spain’s population will be like in 50 years

With regards to ELA specifically, it has long been felt that further legislation was necessary to improve the lives and care of ELA sufferers.

“It is absolutely necessary and humanely essential. We cannot allow people to choose to die every day for economic reasons, when what they really want is to live,” said the Spanish ALS Association in March when previous proposals were put forward.

Why is it back in the news?

Essentially because various parties have put forward drafts and the government coalition of PSOE-Sumar has now made its own proposal, expanding the law beyond ALS suffers to include other neurodegenerative disorders, such as:

  • Alzheimer’s disease and other memory disorders.
  • Ataxia.
  • Huntington’s disease.
  • Parkinson’s disease.
  • Motor neurone disease.
  • Multiple system atrophy.
  • Progressive supranuclear palsy.

What does the government propose?

By expanding the scope of neurodegenerative disorders covered by the law, the Ministry of Social Rights wants to include the more than 1 million people in Spain who suffer from them, and to give them the benefits previously outlined for ALS sufferers.

In broad strokes, this means creating quicker responses so that people who have been diagnosed with neurodegenerative diseases and need care can be assessed and access, in the shortest possible time, the services and benefits available to them.

What will the law actually do?

According to a statement from La Moncloa, one of its main objectives is to “rationalise and reduce procedures as much as possible, to ensure that there is no significant time lag between the process of a disease and the response offered to sufferers by public administrations in all areas.”

The Health Ministry will also update the previous Approach to Amyotrophic Lateral Sclerosis, which dates back to 2017, to incorporate new goals and actions in the care of people with ALS.

Recommendations for the broader Neurodegenerative Diseases Strategy related to prevention, care and research will also be implemented.

It will include a review of the National Health System’s Portfolio of Services, within the Commission on Benefits, Assurance and Funding of the Inter-territorial Council of the National Health System, with regard to neuromuscular diseases, especially in the field of orthoprosthesis.

Coordination between health and social services will be improved, recognising the role of Spain’s regional health services in establishing the necessary coordination procedures so that patients can access multidisciplinary, continuous and “as individualised as possible.”

It will also introduce a benefit (bono social eléctrico) for family’s of neurodegenerative patients that are dependent on a machine connected to the grid.

When will it finally pass?

It’s unclear, despite the fact that most parties in the Spanish Congress are behind the legislation. The final bill should pass fairly easily, however, though it’s unclear when a final vote will actually be held.

Spain’s Minister for Social Rights, Consumer Affairs and Agenda 2030, Pablo Bustinduy, said this week he is “convinced” that it will be passed during this legislature, swearing that his department will do everything in its power “to achieve it” as soon as possible.

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