More than 100 days of waiting for the specialist to visit you

BarcelonaFaced with a cancer diagnosis, a disease with a poor prognosis, or a highly complex operation, Catalan citizens continue to knock on the door of the public health system, even though the number of people with private insurance grows year after year and a third of the population already has double coverage. This increase in private coverage is due, above all, to the difficulties in accessing certain health services, especially when the care is not urgent and is more focused on prevention and improving quality of life.

While the wait to enter the operating room for a tumor or a cardiovascular disease is adequate and has remained at similar figures since 2019 despite the shock of the pandemic, the time for a test or a first visit with a specialist is progressively increasing and thousands of Catalans wait longer than the law allows. These long delays – the great Achilles' heel of the public network for years – are an increasingly heavy burden that can shake the confidence that is still maintained, despite everything, in the Catalan public system when it comes to complex interventions.

In Catalonia, there are more than 200,000 people waiting for an operation, more than 200,000 awaiting a test, and more than 500,000 in line for a first visit with a specialist, according to the latest data from the Department of Health this February. Waiting lists are an indicator of the efficiency of the healthcare system, but to evaluate it, one should not consider the total number of people awaiting an operation, as there are more and more citizens to attend to – 100,000 new users are added to the system each year – but rather focus on waiting times.

The law sets maximum deadlines for operations, specialist visits, and diagnostic tests that have been decided based on the severity of each illness and its repercussions on patients' lives. Healthcare centers must adhere to these deadlines to attend to patients within the indicated time, and when someone waits longer than the law determines, it is considered to be out of deadline.

Thus, a malignant tumor must be operated on within a maximum of 45 days, the obstruction of blood vessels supplying blood to the heart, within a maximum of three months, and a knee or hip prosthesis must be placed within a maximum of six months. People awaiting cataract surgery or breast reconstruction after cancer must also be treated within half a year of being placed on the waiting list. The rest of the surgical interventions do not have a guaranteed maximum time, but Health also states that all procedures must be responded to within a year at most from when the patient is on the waiting list, including those of lower priority that do not pose any vital risk.

Department sources explain to ARA that the pandemic halted many of these procedures, which is why when the impact of covid decreased, a great surgical effort was made with the aim of reducing the lists. Currently, of the more than 200,000 people awaiting surgery, only 1,318 have been waiting for more than a year.

On the other hand, pending appointments are diagnostic tests and specialist visits, where more and more people find themselves waiting longer than they should. These are considered to be out of time. In both cases, the patient must be attended to within a maximum of 30 days if it is a preferred priority and within a maximum of three months if it is an ordinary priority. Nevertheless, Catalans wait an average of 80 days for a diagnostic test and 102 for a first visit with a specialist.

The department admits that more resources are needed to improve waiting times, especially in primary care, to avoid referring patients who could be treated in outpatient clinics to specialists. Currently, of all the first scheduled visits with a specialist, almost half are included in a waiting list that exceeds the marked time, and of all pending tests, one in four are included in a list that exceeds the three months set by Catalan legislation.

The most saturated

The most saturated specialties currently are allergy, otolaryngology, urology, and traumatology. In the latter, in fact, the average wait across the country is almost 200 days and seven out of ten Catalan patients are on a traumatology waiting list that exceeds the times set by the department. In otolaryngology, half of the patients are on a waiting list that exceeds the set time and, in urology, a third, with an average of 133 and 167 days for a first visit, respectively.

For the vice-president of the Metges de Catalunya union, Josep Maria Serra, this data is a demonstration of the lack of professionals there is, which is exacerbated outside of Barcelona and its metropolitan area. "There is no territorial equity, the centers do not meet the fixed deadlines and patients have to travel more and more kilometers to be seen by a specialist," he laments.

Along the same lines, Health sources acknowledge that access to specialists "cannot always be close to home", but they argue that the department is working to ensure that all citizens have access to the "basic package" of specialists without having to travel. Regarding diagnostic tests, there are four that exceed 100 days: electromyography, which studies nerve function and detects some neuromuscular diseases affecting muscles; esophagogastric endoscopy, which identifies the causes of bleeding or digestive discomfort, such as stomach pain, heartburn, or difficulty swallowing; ergometry, also known as a stress test, used to detect possible cardiac lesions like angina pectoris; and polysomnography, performed to detect sleep disorders.

Strengthening primary care

The pandemic increased the number of people on waiting lists who were outside the deadline, which is why in 2023 the Department of Health launched a plan to improve surgical figures, that is, the lists of those awaiting an operation. The plan has resulted in current figures being even better than before the outbreak of the coronavirus, but, on the other hand, waiting lists for diagnostic tests and specialist visits have more people outside the deadline than ever before. Every month there are meetings between Health and the different health regions to assess the situation of each center and decide whether any action needs to be taken to improve the lists, such as, for example, referring patients to other centers or incorporating more professionals to increase the number of visits, according to sources from the department.

However, the same sources explain that the key to improving data is to strengthen primary care and increase the number of professionals. Here Serra agrees with the department, as she considers that primary care professionals have such an overload of care that they ask patients to visit a specialist because there is not enough time to attend to everyone.

"We can't cope and they are referred," laments the vice-president of Metges de Catalunya, who warns that waiting lists for specialists and complementary tests will continue to increase given the current state of primary care. On the other hand, Salut maintains that relations between CAPs and hospitals are being strengthened to improve this data, as centers will be able to share professionals, which in their opinion will reduce waiting lists.

The reality today, however, is that Catalans already wait more than three months for a visit to a specialist doctor and there are more than 200,000 who are on a waiting list that exceeds the time set by law. The public system lives under constant and growing pressure while professionals ask the department for more resources to alleviate the situation and guarantee accessibility to a healthcare system that has long called for a transformation that has yet to arrive.