The emergency department of Spanish hospitals are up to the top. The show the doctors who work in them, that complain about saturation, lack of staff and a dubious health education of some citizens, who often come to this service without a real need. Also shown in the data. In the last five years with available statistics, the number of emergencies treated in hospitals has increased by 9%, according to data from the autonomous communities gathered by this newspaper (see the figure). Meanwhile, the Spanish population is virtually stagnant.
What leads citizens to rely increasingly on this service? The experts consulted point to reasons that have to do with patients, who increasingly demand immediacy for ailments that are not always serious or urgent; but also with the system, which is not able to resolve the problems quickly enough in other instances, and leads users to go to a service where they know they will be cared for at the time.
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Of a patient who goes to the Emergency room for a rash that has worms in one eye-socket empty, “The family doctor takes a week”
The consequences are negative for the entire system. And also for the citizens. Although hospitals apply triajes to prioritise the most urgent cases, the time spent on others which are not subtracted staff and infrastructure to those who need it most. And the cost is paid with the money of all: while a primary care visit has a cost of around 70 euros (depending on the autonomous communities) an emergency care without hospitalization reaches 300.
A survey last December of the association of consumers Facua showed that 35% of users have to wait a week or more to make an appointment with your family doctor. Here lies part of the problem. “When a person is sick, make an appointment and they give it within 10 days, or go to your gp without an appointment and the overload still more or going to the emergency room, which causes that they are overwhelmed,” says Vicente Matas, a member of Primary Care from the college Medical Organisation.
“When you have a problem that you think is urgent that you want to solve, and luckily we have a health system in which almost all the world has a hospital close by, providing easy access”, apostille Rafael Reig, head of trade Union Action the trade union of nursing Satse. “But many times —it continues— there is no urgency is real; more than 80% go on their own initiative and do not require hospitalisation or referral to a doctor.”
The professionals working in the emergency department, the hospitals recount from cases that come to ask for a low (corresponding to elementary school), to advance a diagnostic test, any scratch.
Although some autonomous communities are beginning to publish data on the triajes, that is to say, how much of the population goes for ailments minor, serious or very serious, there are still too few. In the memories of some also figure the percentage of hospital admissions of all the attentions of emergency. In most, whilst raising the number of cases, it lowers the percentage of them that have to stay in the hospital. In Madrid, for example, amounted to 11.5% in 2012, and has gone down to 9.8% in 2018. “This is one of the facts that indicate that there is sufficient severity, although not all urgent cases requiring internment,” says Ignacio González Lillo, master in Health Management, emergency medical, and primary.
“we’re in a society that is accustomed to immediacy in everything, and the confused with urgency,” says Lillo, who believes that patients with little discretion or take advantage of the system are part of the problem, but not the only, nor the principal: “There is a fault in the structure: the primary care, that is the one that should resolve most of the problems, it is abandoned”.
The study Estimated the supply and demand of medical specialists. Spain 2018-2030, showed that there are nine specialties in which there are difficulties to meet the needs of the autonomous communities. They are led by the primary care: pediatrics and family and community medicine. While in the hospitals the number of doctors has grown by 7%, from 2014 to 2017, in elementary school remains stalled.
“We have passed an economic crisis that resulted in the healing. There were staff cuts that have been correcting with the time, but we have not got the figures necessary,” says Gabriel del Pozo, secretary general of the Confederation State of trade Unions Medical (CESM). And this has been primed with the primary. While the investment in specialized is already above pre-crisis levels, in health-care facilities in 2017 was still 1,000 million euros (9.5%) lower than in 2009.
In a health system like the Spanish, the impact of all this varies a lot in function of the autonomous communities. Although the load of the emergency department has grown in all, there are large differences between the 459 attentions per 1,000 inhabitants of Navarra and the more than 700 of Andalusia, Madrid, Balearic islands, Ceuta and Melilla.
beyond the resources of individual autonomy, this is also explained, as Well, by the floating population. “The tourists that do not have specific allocation of physician come to the emergency room. This may be the case of Madrid, the Balearic islands and Andalusia. In the enclaves of Ceuta and Melilla, has more to do with catering to many urgent needs of the countries around. There are many citizens originating in Morocco with citizenship (and health card) european who has retired or is on vacation in his country, but when you have a disease go to a system that gives you more confidence and security,” reports the union leader.
