Why does Catalonia triple the waiting rate for an operation compared to Madrid?

Barcelona"We are the most transparent autonomous community in the Spanish state, and that's how we fare when reports comparing healthcare waiting lists are released," lament sources from the Ministry of Health regarding the disparity between different healthcare systems in Spain. Having data is essential to define healthcare policy priorities, and waiting lists are a great indicator of the system's efficiency, but for some time now, Catalonia has criticized that not all territories collect data in the same way. Health competencies fall to each autonomous community, which is why the Ministry of Health prepares reports with the data communicated by each territory. According to the latest state publication, Catalonia is the community with the most patients waiting to enter an operating room and the second with the highest waiting time, around 148 days on average for an operation. However, from Health, they question the report and insist that not all communities share the data with the same exhaustiveness.

According to the data in this state report, Catalonia is second with the most patients who have been waiting for more than six months to enter the operating room and almost triples the rate of people waiting for an operation compared to Madrid. The director of the care area of the Catalan Health Service (CatSalut), Ignasi Carrasco, assures that there are autonomous communities that do not register patients on the waiting list until they are in the pre-operative stage or that they remove people from the waiting list when they are referred to the private circuit. This leads to territories like Madrid having much better figures than Catalonia, with a similar population volume. "We argue that we must be as exhaustive as possible because it is a right of citizenship, we must be transparent," defends Carrasco.

Thus, while in Catalonia there are more than 200,000 people waiting for an intervention, in Madrid there are almost 80,000, of which only 0.5% have been waiting for more than six months to enter the operating room. This percentage in Catalonia rises to 30%. The same happens with the average waiting time, which in the Spanish capital is 49 days, 100 days less than here. In specialist consultations, a paradoxical situation occurs: Madrid has a larger total volume of patients, but Catalonia takes much longer to attend to them. Specifically, the almost 800,000 people waiting for a visit in Madrid wait an average of 63 days, while in Catalan centers the average wait is 112 days and there is a list with 546,000 people.

"If we do not include it at the time the intervention is indicated, we are hiding a reality that directly affects people," warns Carrasco, who insists on questioning the asymmetry of the data and advocates for Catalonia's transparency. The director of the CatSalut's care area argues that if there is no real standardization of waiting list data between communities, those who declare more may appear to be those who function worse, which is why he insists that notification criteria to the ministry must be harmonized. Carrasco says that in recent years they have worked to establish a common framework among all autonomous communities that allows for more reliable data comparison, especially regarding the entry time to the list, the type of activity included, and the follow-up of referred patients, but for the moment there is no prospect.

The area of waiting lists is not the only one affected by the differences in the notification of health information between communities. The notification of contagions and deaths related to covid also caused a stir, especially by Madrid, and from the top of Health – then led by Junts – it was reproached that the ministry was not more demanding with all autonomous governments to report more complete data. A criticism that the Madrid health sector also made, for example, when it denounced a "fiddling with data" that minimized the impact of the pandemic in the territory by its administration and, in contrast, penalized Catalonia informationally, as it reported much more.

Aspects to improve

Likewise, in Catalonia there are other voices that criticize the lack of transparency of waiting lists and demand a reformulation. According to the department's regulations, the maximum waiting time for a first specialist visit should be three months if it is an ordinary first visit and one month if it is a preferential first visit. However, Health does not specify which pending visits are ordinary and which are preferential when it publishes waiting list data. Union sources explain to ARA that, since this detail is missing, it is not possible to know how many urgent visits are being delayed longer than the department states, and only the average waiting time can be assessed, which is also more than three months.

Furthermore, the ministry only publishes data for 12 medical specialties, but there are more than 40, the same sources insist. Health groups the rest of the specialties into a single category, and according to the latest government data, there are more than 150,000 people waiting for a first visit, of which more than half are included in a list with a waiting time exceeding the three months stipulated by the regulations. In fact, the average waiting time for the rest of the specialties, including angiology, endocrinology, or hematology, is 104 days for a first visit. Sources from CatSalut insist that there are many specialties and only the most requested ones are monitored.

In contrast, union sources criticize that to know the details of the rest of the specialties, a transparency request must be made: "This hinders oversight. It would be good for all data to be open, especially since the department has it." The same applies to surgical operations, some of which are grouped together, such as hysteroscopy, which is a procedure to correct uterine prolapse, and its details cannot be known. There are almost 10,000 people waiting for "another intervention," 579 of whom are included in a list with an average waiting time of more than a year to undergo surgery.