The ‘trap’ of waiting lists in Madrid is in the specialist: 767,000 people are waiting for a first appointment

The Community of Madrid congratulates every time the Ministry of Health publishes waiting list data. The figures smile at them. “We once again lead the shortest waiting times on the surgical list,” stated the counselor of the branch, Fátima Matute, after knowing the statistics for June 2024. Behind these data, however, there are other less visible and media-friendly ones, such as appointments with the specialist, who also show how the Madrid health system works.

The regional government publishes the data month by month so it is possible to have a more updated photograph. The traffic jam is getting bigger and bigger. In October, the last figure available, the list was twice as large as in February 2020, before the pandemic. Then there were 453,000 patients inside. After the lockdown, it had dropped to 188,000. Now, the list is made up of 767,000.

Meanwhile, patients pending an operation maintain a stable curve, without major increases or decreases, as can be seen in the graph below. Madrid is the autonomous community with the largest gap between one list and another.

“What the data tells us is that hospitals are not able to evacuate patients because the admission rate is higher than what the system can handle,” explains Beatriz González López-Valcárcel, researcher in Health Economics at the University of Las Palmas de Gran Canaria.

Those who know about health planning repeat that the situation should not be measured only by the volume of the list, but also – and above all – by the time expected. And Madrid does not fare well here either: the people who will wait more than 90 days have multiplied by four compared to 2019. They are more than half (60%) of those who make up the list.

With these figures, the average time patients have been waiting has also doubled. Before the pandemic, it was around 40 days. In recent months it has doubled to reach 70-80 days.

González López-Valcárcel cannot explain “how” such a steep rise in the demand for specialists can occur, even knowing that the “relationship is not so direct, that not all of these consultations later lead to an operation.” “The fact that there are many people who wait a long time is serious because what matters to the patient is how long they wait and not how many people there are. If in surgeries the inputs and outputs are balanced, that does not happen in first consultations. It is growing and worrying, accelerated in the last two years,” the expert develops.

Although Madrid had an average wait of 60 days as of June 2024 – much lower than the national average, of almost 85 –, patients are accumulating at a dizzying rate in Madrid hospitals waiting for an appointment: the rate of people waiting It is the highest in all of Spain (12% of the population) and almost three out of every four (72.8%) have to wait more than two months. That is to say, there are many people who expect a lot. This proportion that occurs in Madrid is only surpassed, if compared to other communities, by the Canary Islands. This was the situation on June 30.

José Manuel Freire, professor at the National School of Public Health and former Health spokesperson for the Socialist Parliamentary Group in the Madrid Assembly, compares waiting lists to a swamp: “If you hold back a lot at the top, the flow is smoother. This, transferred to the lists, means that if you retain people in the previous stage, if you put the barrier in seeing the specialist, later there will be less queue for surgery.” Ángela Hernández, general secretary of the Amyts union, agrees with the analysis. “The situation can be shaped by opening more or less first consultations and depending on that, patients accumulate above or below.” It is worth clarifying, however, that not all people who go to the specialist end up in an operating room.

The Ministry of Health frames the different trends seen in the lists as normal, depending on whether they are surgical or consultations. “It responds, to a large extent, to the different nature of these processes and the factors that influence their management. While the indication for a surgical intervention can only be made by a surgical specialist after evaluating the patient in consultation, the indication for a first consultation with a hospital specialty can be made by any doctor,” a spokesperson answers the questions posed by this medium.

In the department headed by Fátima Matute, they maintain, despite the data, that the waiting lists to see a specialist in Madrid “present a general trend towards stabilization, although with slight increases in specific periods” such as the summer.

The pandemic generated a break in the data series. Not because they stopped being broadcast, but because they responded to very strange dynamics: the patients were stuck on the list; They neither entered – because they did not have access to the first consultations – nor left – the operating rooms were paralyzed and so were the specialists – and those who were inside saw the wait increase.

After this very particular situation, a return to normality could be expected, which has not happened in the case of external consultations: the list is much broader than before 2020 and the average delay is double (from 35 to 70 days), according to the October data provided by the Ministry of Health.

Freire finds another complementary explanation to the data: “In general, governments care a lot about how they appear in the photo and the surgical waiting list is always more visible, so it is likely that there is more interest in reducing it than in minimizing the wait.” in consultations.” The former socialist deputy also adds that “surgery generates more money” if it is referred to privatized centers. In Madrid there are five public network centers managed by private companies (four of them are from Quirón). For each new patient they receive referred to lighten the lists – and who is from outside their area – they receive a payment, both for surgeries and for first consultations.

Primary Care professionals have also noticed this increase in waits. They are the ones who decide whether to refer patients to specialists. “We are experiencing it badly because we are the first level and we find ourselves with this,” admits Valle Coronado, family doctor and secretary of the Spanish Society of Public Health and Health Administration (SESPAS). “We have the option of preferential or we send a direct flyer urgently to the hospital. There are things that can be reasonably delayed, a month or two, but not more than that,” he continues.

Coronado does not feel there is “pressure” to refer because patients prefer to be treated by specialists. He also denies that the reason for the growth in waiting is that family doctors send more cases to outpatient clinics due to the overload experienced by Primary Care, a hypothesis drawn by several experts consulted by this medium. “Now, the more diagnostic means we have, the more we can alleviate that burden on this part,” the doctor concludes.