Long waiting lists, shortage of nurses and doctors and insufficient coverage in the case of medications and dental care. These are the main problems that afflict the Spanish health system according to him annual report published this Thursday by the European Commission and the OECD. A study that warns that the budgetary pressure on public health will increase over the next few years due to the aging population.

Spain has the highest life expectancy in the European Union (83.4 years, 2.5 years above the average) and "their social inequality in health matters is less pronounced than in many other countries". However, almost 60% of Spaniards over 65 suffer from some chronic illness and one in five suffer some type of disability, which increases the demand for health systems and long-term care.

The main risk factor is still smoking. Although rates have declined in the last 15 years, 22% of Spanish adults smoke daily, above the EU average (19%). Obesity has increased and already affects 17% of adults (above 15% of community average). On the contrary, the rate of adults who recognize high alcohol consumption is among the lowest in Europe (9%).

A health expenditure below average

The percentage of public spending on health in Spain fell after the economic crisis of 2009 due to cost reduction measures and increased drug co-payments, the report said. In recent years it has started to rise again, although still below the pre-crisis level.

In 2017, health expenditure per capita (adjusted for differences in purchasing power) was 2,371 euros, 15% below the EU average (2,884 euros). Health expenditure stands at 8.9% of GDP, also below the community average (9.8%).

Looking to the future, population aging and moderate economic growth are expected to add pressure in the coming years and decades. According to Brussels calculations, public health spending will increase 0.5 percentage points of GDP between 2016 and 2070, while public spending on long-term care will rise 1.3 points. An increase that "may jeopardize medium and long term budget sustainability".

Around 71% of health expenditure is financed with public funds, while direct payments by patients amount to 24% of total health expenditure, a percentage much higher than the average of 16% in the EU. That is explained by the increase in drug copayments since 2012 and because dental care is not covered by social security.

"Spanish citizens have a national health system whose coverage decreases in the case of medicines and does not include dental care, which generates greater needs, particularly for low-income people"highlights the Brussels study.

Long waiting lists


Spain has one of the lowest mortality rates due to preventable and treatable causes, indicating that public health and healthcare interventions are, in general, effective in preventing premature mortality. Nevertheless, "waiting times for medical consultations and scheduled surgical interventions still a problem"notes the report.

After some reductions before the economic crisis, waiting lists increased again as of 2011 as a result of budget restrictions. On average, waiting times across the country for cataract surgery rose from about 90 days in 2010 to 100 days in 2018. Similarly, the list for hip arthroplasty went from 135 days in 2010 to 150 in 2018.

There is also considerable regional variations in the waiting times. For a hip replacement, they range between more than 150 days in Castilla-La Mancha and the Canary Islands and around 50 days in Madrid, La Rioja and Navarra. The measures applied so far in the different autonomous communities have not been sufficient to respond to the problem.

Shortage of nurses and high temporality


Spain has a relatively high number of doctors (3.9 per thousand inhabitants compared to 3.6 on average in the EU), but a small number of nurses (5.7 per thousand inhabitants versus 8.5%). The report also warns that an important part of health personnel "they have temporary contracts, which increases the staff turnover rate".

"There is a growing concern about the shortage of nurses and doctors, particularly family doctors, since many are approaching retirement age. The development of more consistent medical education and training policies has been hampered by the lack of a clear and shared vision between educational and health authorities about medium and long-term needs, "Brussels warns.