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 the then Minister of Health, Leire Pajín. However, a decade later the communities do not comply with these guarantees and delays are not penalized either. It was never contemplated in the norm that this was the case.
“That’s the problem, maybe it’s a little embarrassing, 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 would change the way it measures delays because it does not give a true image of how things are. Within these changes, a Health spokesperson assures when asked by this medium, the royal decree that establishes the limits could also be reviewed. Decisions will be made based on the conclusions of a working group on waiting lists that “is starting to work,” says Health.
The most extreme situation occurs in Extremadura, where almost half of the patients awaiting knee surgery exceed the threshold set by the norm. The average waiting time is 213 days. Hip prostheses in the same region also take longer than necessary for 40% of the patients on the list, although all communities – none are spared – are non-compliant in this intervention, according to the data analysis that has been carried out. made elDiario.es based on official statistics offered by the Ministry of Health twice a year.
If we look at knee replacement, Extremadura is not the only one that comes out badly in the photograph. Andalusia, Aragon and Cantabria keep a third of the people who need this intervention waiting more than six months. In contrast is Madrid, with a 47-day wait and practically all patients operated on within this period. In the search engine above you can check the situation in each autonomous community for the five interventions with a waiting guarantee: cataracts, knee replacement, hip replacement, coronary heart surgery (by pass) and valvular heart surgery.
There is only one intervention with which all communities, even if they are more or less delayed, meet the objective: the by pass in the heart. It is an operation to restore blood flow to a blocked artery. No one in Spain waits more than six months if they require this intervention, although there are large differences within the legal margin between the three days on average expected in Euskadi and the 104 in Cantabria. But this is an exception.
In the event that the operation consists of installing a valve, things get worse: one in four people from Castilian-La Mancha and Extremadura who have the surgery prescribed have to wait more than six months. The Ministry of Health warned this in a press release to report the latest waiting list data: “There is a slight deviation from the objective of 2.7%”, that is, almost 3% of patients who require this surgery wait more than 180 days.
This is how the wait of more than three months has varied in each community
Semi-annual evolution of the percentage of patients who have been waiting for an operation for more than 180 days, by community and surgical specialty
Source: Ministry of Health
In cataracts – formed when an area of the lens of the eye becomes cloudy – 6.6% of patients nationwide spend more than 180 days on the list, although in reality they are accumulated mainly in two communities that get a bad grade: Castilla -La Mancha (26%) and Aragon (20%). Hips and knees have a much longer wait by territory and by affected patients: 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 and also how it was set up ten years ago. “The system is a bit senseless because it is not so much the time as the state in which the person is. The impact of having cataracts is not the same if you are a bus driver or something else,” says Salvador Peiró, specialist in Preventive Medicine and Public Health. “Now,” he adds next, “no community likes to appear in the photo.” “We must fix the structural and budgetary problems of the National Health System and less play with implausible penalties,” says Repullo.
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