The long waiting lists in public health care, a problem in improving quality

Abstract

Citizens’ perception and opinion about the Spanish public health system continues to be good. Overall satisfaction with the health system was rated 6.5 out of 10 in the latest poll performed in Spain, while in Catalonia, the latest survey of user satisfaction with the public health system gave 7.6 for Primary Care and 8.2 for Hospital Care. However, all the surveys also show that the degree of dissatisfaction has increased in the last 10 years, particularly with the long waits to get an appointment, to be admitted for surgery and to perform diagnostic tests. In short, in users’ opinion, the problem with public health is a lack of accessibility. The long waiting lists may be further lengthened by lack of planning and management or to people jumping the queue through personal recommendation, or because they are relatives of health personnel or VIPS. Upon analysing how the waiting lists have evolved in Catalonia since 2000, it is seen that the lists for 14 monitored surgical procedures have been reduced by 19.8 por ciento during 2007 and the average time from referral to surgery has been shortened by 1.4 months. However, this “average” sometimes conceals long waits by some patients or for certain procedures. This paper analyses the possible causes of the long waits for surgery. One group of causes could be due to an increase in demand, another group could be due to the lack of supply, and a final group may be due to defects in the planning, management and payment system. All of these causes will have an effect on the long lists and specific measures will be required to address them, above and beyond mere “contingency plans” (increasing the supply, sometimes resorting to payment per procedure or outsourcing to the private sector) that may have results that are contrary to those wished. If they are to be effective, such measures will require major changes in planning and management of the system as a whole and in health professionals’ and citizens’ attitudes.