Madrid.- Amnesty International has carried out a new analysis of the latest available data on health spending in Spain and has reached the worrying conclusion that one more year Spain does not prioritize investment in health to make it progressively higher each year, as indicated by the international obligations contracted. On the contrary: For the second consecutive year there has been a reduction in spending: in 2022 public spending on health was 0.94% lower than in 2021. The primary carethe gateway to the system and of which all international organizations agree in pointing out its importance to achieve universality in the right to health, is one of the hardest hit items: in 13 years, the level of investment not only has not has increased, but has not yet reached the figure prior to the austerity measures, since it is a 0.02% lower than in 2009.
One of the consequences of this lack of prioritization is waiting times in primary care. At the moment 7 out of 10 people in Spain have to wait more than 48 hours to be seen due to lack of appointment availability. In 2023, only 21.43% of primary care consultation requests have been attended to in the first 24 or 48 hours. 69.8% of appointments were attended later due to lack of availability, in most cases (more than 50%) being attended to after a week.
“Without adequate funding, without the prioritization of public spending on health, and without the Autonomous Communities landing it in an adequate investment and progressive in the public health system, the right to health of Spanish society will be increasingly at risk,” says Teresa García del Vello, responsible for work on economic, social and cultural rights at Amnesty International Spain and author of the report.
“Thirteen years have passed since the so-called austerity measures were implemented, which led to harsh cuts in public health spending and caused suffering and pain in sick people. It has also been four since the pandemic. But the authorities do not react as they should: increasing public health spending to comply with their obligation to be progressive in the adoption of both the general state and regional budgets. This is necessary, among other things, to face new challenges such as future health crises or climate change,” says García del Vello.
By Communitiesthe data are equally alarming: all have allocated less in public health spending in 2022 compared to 2021, except the Community of Madrid, which increases it by 2.04%. The four Communities with the greatest loss are Castilla-La Mancha (-6.36%), Extremadura (-3.32%), Aragón (-3.31%) and Navarra (-3.15%).
There is six Communities that spend less on health in 2022 than in 2009and therefore have not recovered from the austerity measures: Castilla-La Mancha invests 11.17% less in 2022 than in 2009, followed by La Rioja (-7.17%), Extremadura (-6.69 %), Asturias (-5.46%); Galicia (-4.73%) and Aragón (-1.51%).
Amnesty International has also analyzed the variation in the weight that public health spending has in public spending in general. “The conclusion is the same: the progressive reduction in the percentage of public spending dedicated to health is worrying. We can see that it is reduced in 2022 compared to 2019, but also compared to 2021. Are we headed for another lost decade?“García del Vello laments.
Spain also loses in the European comparison. The 2023 OECD report reflects that while the average of GDP dedicated to health spending in the EU is 11%, in Spain it is 10.7% in 2021. This is no exception: the different OECD reports OECD show that in all the years analyzed it was below.
Endless waiting times
The lack of progressivity in public health spending is especially evident in primary care: in 2022 Spain has practically the same level of spending as in 2009, and in 2022 there is a drop compared to the previous year of 2.06% at the national level. state. Seven Autonomous Communities have decreased, since 2009, the amount allocated to spending on primary care: Aragón (-15.22%), Extremadura (-11.50%), Castilla y León (-11.48%), Castilla-La Mancha (-9.78%), Galicia (-7.43%), Catalonia (-4.17%) and Community of Madrid (-0.01%).
Furthermore, non-urgent appointments cannot be attended to between the first 24 and 48 hours, thus contravening the objectives established in 2019 in the Strategic Framework for primary and community care approved by the Autonomous Communities and the Ministry of Health. And in all the Autonomous Communities their average number of waiting days after 48 hours has increased in comparison with 2018. In 2018 the average waiting time in Spain was 4.77 and in 2023 it stands at 9.12, that is to say a waiting increase of four days in five years. The ones with the greatest increase in days are the Canary Islands, Andalusia and the Community of Madrid.
Whether or not you will be seen soon in an outpatient clinic in Spain depends on some issues such as where you live. In the case of Madrid, for example, being the only community that has increased its investment in 2022 compared to 2021 is not reflected in the waiting times in primary care: and it is, together with Andalusia, one of those with the worst results. regarding the percentage of appointments attended after 48 hours with 74%. Andalusia presents 78.08% of appointments attended after 48 hours. Another paradigmatic case is that of the Canary Islands, since, although investment in healthcare has increased, the percentage of appointments attended in the 24 and 48 hours since 2018 has not stopped decreasing, placing it as the Community that attends the most appointments after the first 48 hours. hours, with 79.20%.
Some encouraging data
One of the few indicators that show good results are the ratios of medical personnel in primary care per thousand inhabitants, which in 2022 have had a slight increase: 0.78 compared to 0.77 in 2021 at the national level. Also the nursing staff ratio increases slightly in 2022 compared to 2021 (0.7 vs. 0.66) at the national level.
In this analysis, which the organization has sent to all the corresponding state and regional authorities, Amnesty International points out a series of recommendations. Because it is true that since the beginning of the XV Legislature some positive initiatives have been carried out, such as the creation of the Primary and Community Care Commission (CAPYCO), which approved in June the distribution of 172 million euros that must be approved by the Council of Ministers and the Interterritorial Council of the National Health System (SNS). Also the creation of the Waiting Lists Working Group of the National Health System. Or the processing of the Bill on universality of the National Health System, currently in the amendment phase in Congress. But the different authorities still must implement a series of measures. Among them, increase public health spending to meet its obligation of progressivity and prioritize and boost spending on primary care.
More information
The data on which this analysis has been carried out is from the year 2022, the latest data published by the Ministry of Health as of October 2024. Last February, Amnesty International published the analysis of the 2021 health spending data, in a report in which it already warned of the lack of progressivity in investment in public health compared to investment in private health.
The organization has a campaign underway, Defiendetusanidad.org, to demand from health authorities, both at the state and regional level, a greater commitment to the right to health.