The 2023 annual report of the National Health System (SNS), published in August 2024 by the Ministry of Health, leaves no room for doubt: the overall state of healthcare and the health system is worsening rapidly.
This report provides a detailed overview of the population’s health status and the functioning of the healthcare system, based on data collected during 2023 and previous years.
Among the numerous data points, the decline in care quality stands out, reflected in the record increase in waiting times in Primary Care and the reduction in the ratios of healthcare personnel.
Negative record in primary care waiting times
In 2019, 15% of Spaniards obtained an appointment with their general practitioner on the same day they requested it, 26.8% the next day, and 50% after more than a day.
Four years later, the situation has significantly worsened.
Currently, only 9.1% get an appointment the same day, 12% the next day, and the vast majority (69.8%) have to wait more than a day, representing a 20% increase during this period. Furthermore, the average waiting time to see a general practitioner reached a record of 9.12 days in 2023, compared to 8.9 days in 2022.
The number of medical and nursing professionals in care functions has also decreased.
According to the report, in 2022 the ratio of doctors per 1,000 inhabitants dropped to 4.3, down from the peak of 4.6 reached in 2020.
Similarly, the nurse ratio fell to 6.1 per 1,000 inhabitants, below the 6.4 recorded in 2021.
Despite Primary Care being considered the foundation of the SNS, only 21.5% of doctors work in this sector, with a ratio of 0.77 doctors per 1,000 inhabitants. A similar situation occurs in nursing, where less than 15% of the total work in Primary Care.
This report reveals that 763,000 professionals work in the healthcare system, of whom 172,000 are doctors (3.6 per 1,000 inhabitants) and 221,000 are nurses (4.6 per 1,000 inhabitants).
In this regard, entities like CSIF (Central Sindical Independiente y de Funcionarios) denounce that the healthcare system faces a severe staff shortage: 9,500 general practitioners, 130,000 nurses, 1,250 midwives, 1,100 pediatricians, and 44,000 nursing care assistants (TCAEs) are needed, in addition to other professional categories such as administrative staff, healthcare technicians, and orderlies.
Poor evaluation of the healthcare system
The satisfaction of Spaniards with the SNS has also declined.
The system’s rating dropped to 6.27 points out of 10 in 2023, compared to 6.74 points in 2019, before the pandemic. In 2023, only 56.7% of respondents considered that the system works well or fairly well, compared to 72.1% in 2019. Additionally, 14.3% believe that profound changes are needed, a significant increase from 4.1% in 2019.
The best-rated services are the 061/112 emergency services and hospitalization, with 7.4 and 7.2 points out of 10, respectively.
Primary Care received a score of 6.37, and specialized consultations a 6.04. However, only 40.5% of users consider communication between Primary Care and specialized care to be good, while 24% rate it as poor, highlighting one of the main challenges of the SNS.
In 2023, only 56.7% of respondents considered that the system works well or fairly well, compared to 72.1% in 2019.
Healthcare spending increases, but it’s not enough
Public healthcare spending reached 94.694 billion euros (2,001 euros per inhabitant) in 2022, accounting for 7.8% of GDP and nearly 72% of total healthcare spending (131.984 billion euros).
The increase over the last five years was 27%. Curative and rehabilitative care services absorb most of the public healthcare spending (57.2%).
Thus, total public healthcare spending as a percentage of GDP has evolved from 6.40% in 2017 to 7.85% in 2021, with public healthcare spending rising from 1,599 euros in 2017 to 2,001 euros in 2021, a figure still very insufficient and far from the levels of neighboring countries.
Currently, 2,000 euros per person are invested, compared to the European average of 2,746 euros.
The increase over the last five years was 27%. Curative and rehabilitative care services absorb most of the public healthcare spending (57.2%).
Mental Health: anxiety increases among youth
One of the most notable findings of the 2023 National Health System report reflects a high incidence of mental health problems.
34% of Spaniards suffer from some type of mental disorder, with anxiety being the most common.
This problem affects twice as many women as men and has doubled among those under 25 compared to 2016. In this age group, the rate of anxiety disorders has risen to 32.8 cases per 1,000 inhabitants, compared to 16.3 eight years ago.
Additionally, this figure is 30% higher than in 2019, the year before the pandemic.
Other relevant problems include specific learning disorders, which have increased from 14.5 cases per 1,000 inhabitants in 2016 to 29 in 2023, and hyperkinetic disorders, whose rate has risen from 16.6 to 24.9 over the same period. These increases represent 26.6% and 5.2% more than in 2019, respectively.