HBI Deals+Insights / Healthcare Reform

The state of Spain’s NHS driving patients to go private

Spain’s Ministry of Health has released its annual NHS report. HBI looks at three key indicators which show where demand for for-profit healthcare is coming from.

Primary care appointment waiting times are interesting. Spain has issues here, and is splashing €1bn+ over the next two years to try and improve things, as HBI reported last month. As the main way patients access healthcare, the inability to create a high functioning system has created a bottleneck.

More than half of patients were already waiting more than a day for a primary care appointment in 2019, but in 2022 this number skyrocketed to more than two thirds.

Waiting lists for non-urgent surgery are another big driver, as seen in other NHS markets such as the UK where record waiting lists continue to drive an increase in private pay options. In Spain, the region with the worst waiting lists per capita is Rioja with more than 25 in every 1,000 people waiting. Meanwhile the Basque Country is the mainland region which performs best in this regard, with a relatively low 10 in every 1,000 patients waiting. Melilla, an autonomous North African city of Spain, has 5.4 per 1,000, but also has a population of only 85,000.

The two largest regions by population, the Community of Madrid and Catalonia, have vastly different fortunes in this respect with 10.7 and 22.1 per 1,000 people waiting respectively. The Valencian Community, home to Spain’s third largest city by population, has 11.3 in every 1,000 people waiting.

In terms of absolute numbers of patients waiting, Catalonia has the dubious honour of leading the pack with over 165,000 waiters. Meanwhile Andalucia, perhaps the regional posterchild for Spanish medical deserts, comes second with over 136,000 waiters. This doesn’t necessarily mean the region is a great hub for investment as the centre-left PSOE, which all but abolished the public private partnership (PPP) Alzira model in Valencia, ran the region from the death of Franco until 2019.

In every region except for the Basque Country and Melilla 5% or more of those on the waiting list had waited for six months or more. There doesn’t look to be a particularly strong correlation between the number of people on the waiting list per 1,000 and the percentage of long waiters – Rioja is the worst for waiting lists per 1,000 inhabitants but a relatively low percentage of long waiters. The Balearic Islands have the fifth smallest waiting lists per 1,000 inhabitants, is one of 7 regions to have 20%+ of patients waiting for six months or more.

This is not to say there is no correlation as the Basque Country and Melilla performed well on both metrics.

With regards to public perceptions of the country’s NHS, the number of people who believed the system worked well increased between 2016 and 2019, but this faced a steep post-pandemic drop and now sits at 57.1%. Meanwhile 42% now believe the system needs fundamental change or is completely broken – a huge market crying out for better service!

We would welcome your thoughts on this story. Email your views to Joe Quiruga or call 0207 183 3779.