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Catalonia tries to tackle growing waiting lists

BMJ 1998; 316 doi: (Published 21 March 1998) Cite this as: BMJ 1998;316:881
  1. Xavier Bosch
  1. Barcelona

    A new health plan for the Spanish state of Catalonia aims to reduce lengthy waiting lists by boosting local hospitals outside the main cities.

    In recent years, responsibility for public services has been transferred from Spain's central government in Madrid to individual states, and Catalonia is seen as a good model for other states to follow.

    A key objective of Catalonia's health plan is to decentralise resources to reduce the pressure on the main hospitals. These city hospitals would have fewer beds, deal with more specialised cases, and become centres for research. More resources will be spent on outpatient units attached to local hospitals.

    At the moment most of the state's health resources are focused on severe and urgent conditions, with little set aside for more simple cases. A survey last month showed that 40% of Catalonians were unhappy with the public healthcare system, with 22% complaining about long waiting lists. According to data from the health department, the average waiting time for non-urgent operations at the end of 1997 was 211 days for cataract removal, 210 days for treatment of varicose veins, 146 days for a tonsillectomy, and 225 days for a vasectomy. Similar figures are seen in Andalusia, the Basque country, and the Madrid region.

    Although waiting times vary from area to area, they are highest in Barcelona. For example, there are 10000 patients on the waiting list for the Barcelona Health Corporation, which comprises two hospitals, each with a 500 bed capacity. The average wait for inguinal hernia repair is 1.5 years and for cataract removal two years. Lengthy waiting lists means that patients often make simultaneous appointments at several centres.

    Eduard Rius, head of the Catalonian health department, said: “The priority goal for this year is to reduce the waiting lists for less urgent or non-urgent surgical conditions.

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    T'ai chi, the gentle, relaxed form of exercise that originated in ancient China, may lower blood pressure in older people to nearly the same extent as moderate aerobic exercise. Deborah Young, assistant professor at the Johns Hopkins University Medical School in Baltimore presented the results of a pilot study at the American Heart Association's epidemiology and prevention conference last week. She studied 62 sedentary adults aged 60 and over who were not taking treatment for blood pressure and had an average systolic blood pressure of 130-159 mm Hg. After 12 weeks the systolic blood pressure had fallen an average of 8.4 mm Hg in the group taking aerobic exercise group and by 7 mm Hg in the group practising t'ai chi.


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