The Spanish health system offers health care free at the point of service

The 61-year-old Frenchwoman, who lives in Madrid, was kept waiting eight months for the results of tests after seeing a gynaecologist in January.

The results did not come through until September and still she was not told if she had problems with her kidney, as the specialist had suspected. For that she will have to wait until 21 October for more tests.

"It is outrageous. It is too much time to wait to find out if you have something wrong with you," says Tomas.

Sadly, she is not alone.

Lola Marchena, 30, was kept waiting 14 months before she could see a specialist about the conjunctivitis which was making her life a misery.

But even after she had been seen, the specialist could not be sure what was causing the problem and she must come back in November for more tests.

"They didn't tell me what I have and they didn't give me adequate treatment, but the problem keeps coming back," she says.

"The patient feels a growing sense of insecurity and fear about the attention being given to their health," says Jose Maria Mugica, president of the Spanish Organisation of Consumers and Users (OCU).

This feeling of waiting, sometimes for what seems like ages for an all-important appointment with a consultant will be common to many.

But in Spain, like many European countries, just how long you wait for these appointments differs drastically according to where you live.

The OCU, the Spanish equivalent of the British Consumers' Association, conducted a survey of waiting lists to see specialists.

They also examined how long patients might have to wait for the results of diagnostic tests.

For instance, the average waiting time to see a specialist in Castilla La Mancha is 23 days, compared with 81 days in Galicia in north-west Spain or even 140 days in the Canary Islands.  The national average is 65 days – or just over nine weeks.

The OCU discovered that waiting times for tests varied between an average of 87 days (in Extremadura, in western Spain) to just 22 days in Murcia in the south-east. The national average was 63 days.

Nationally is seems much harder to see allergy specialists or neurologists; on average it took 81 days to get an appointment with either.

At the other end of the scale, appointments with traumatologists or general surgeons took only 49 and 58 days to arrive, on average. The national average was 65 days.

So why are waiting lists so varied and, more to the point, so long?

In Spain, the government does not guarantee patients will see a specialist within a certain time, in comparison with Britain (90 days), Ireland (90 days), the Netherlands (35 days) and Finland (15 days).

The Spanish health system, much like the British NHS and other similar systems elsewhere, offers health care free at the point of service. But, of course, this means there are limited resources.

How long you wait differs drastically according to where you live

Other experts blame the Spanish system, which is more inclined to send patients to specialists, when they could be dealt with by the doctors they see first.

Jose Gabriel Cano, a doctor who has written about the waiting list problem, said: "They could save time if the GPs would ask for tests straight away and not leave it to the specialists."

Often specialists' waiting lists are clogged up with cases which could be dealt with by GPs.

Jordi Matias-Guiu, of the Spanish Society of Neurologists, said: "The chronic migraine makes up 40 percent of the cases which are sent to the neurologist. Many of these patients could stay with the GP.

"The same occurs with cases of loss of memory, which occupy up to 25 percent of neurologists' cases."

So what is the Spanish health system doing to cut down these waiting lists? Again, it depends on where you live, as most health authorities are largely run by regional governments and initiatives to cut waiting lists will start at this level.

Some measures which are being considered are sending patients with certain conditions to other medical centres or hospitals in order to cut lists; offer specialists cash incentives to work longer hours with the compensation of extra holidays in the summer and other 'quiet' periods.

Spain is also considering fixing a time by which a citizen must be seen by a specialist to offer an incentive to speed up the system and make it more efficient.  Also they want to prioritise more needy patients and try to get GPs to stop sending other patients with less-serious conditions to specialists.

In Castilla y La Mancha, an experiment to cut waiting lists has slashed the numbers from 157,000 to 56,000 – a 64 percent fall – in just two years.

The secret of this massive cut in the waiting lists was investing EUR 120 million to use surgeries at unusual times, get specialists to work different hours and asking patients to choose other medical centres.

Patients have also been given the legal right to be sent to private clinics and paid for by the regional government, if they were not seen within 40 days. So far only 107 have taken advantage.  
  
Either way, if the results of another survey are anything to go by, something needs to be done if confidence is not to be lost in the system in general. 

The Spanish Centre for Sociological Investigation published figures about patient satisfaction with the health service, which revealed health services in the Canary Islands and Galicia had the worst reputations overall. They both scored 5.37 and 5.56 respectively on a scale of ten.

But also below the average, fixed at 6.18, came the Balearic Islands (5.83), Catalonia (5.96), Murcia (6), Madrid (6.10), Valencia (6.12) and Andalusia (6.14).

Above average in a survey of 6,800 patients carried out last year, came Extremadura (6.3), Cantabria (6.3), Castilla y Leon (6.4), Aragon (6.41), the Basque Country (6.51), La Rioja (6.56), Castilla La-Mancha (6.61), Navarre (6.71) and Asturias (7.26).

The survey also found waiting lists to see surgeons or to get a hospital bed were the longest.

People were also unhappy about the lack of information given to patients.

Of course, this was a subjective survey of patients, but it reveals deep discontent with how people are being treated.    

Updated March 2006

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Subject: hospital waiting lists; living in Spain, expat health