Life on the waitlist

Leo Castaño, 50, knew something was wrong with her health in the summer of 2019. The resident of Seville, Spain, suspected a stomach problem, given her increasingly frequent trips to the restroom. After two months of symptoms, she made an appointment with her general practitioner through Spain’s National Health System. Thanks to the country’s universal healthcare system, she knew the visit and treatment would be free.

It took a month to get an appointment. When she did, Castaño said, the doctor declared she had irritable bowel syndrome and prescribed pills to reduce inflammation. But two weeks later, she was experiencing bleeding. She returned to the doctor and requested blood work. Instead, Castaño said, the doctor determined she had hemorrhoids and prescribed a cream.

In fact, Castaño had rectal cancer. But it took a visit to a private doctor to find out.

Castaño’s story highlights a growing frustration for many Spaniards. Spain’s socialized health system is considered world class, but long waitlists for non­emergency appointments and surgeries are increasingly pushing patients toward private providers to receive vital healthcare in time of illness.

Similar problems are snowballing in two other countries with universal healthcare: In the U.K., 2 in 5 patients wait more than 18 weeks for treatment, and a record 1 in 10 nonemergency operations are now performed by private providers—a nearly 50% surge since before the COVID-19 pandemic. In Canada, the median healthcare wait time rose to a record 30 weeks last year.

Left-wing lawmakers in the United States, such as Sen. Bernie Sanders, continue to call for a single-payer program to deal with mounting healthcare costs. Yet the trend back to private doctors in Spain and elsewhere shows the difficulty of sustaining a healthcare program in which doctors are beholden to bureaucratic systems rather than to their patients.

Anyone born in Spain, married to a Spaniard, or legally working and residing in Spain can access its National Health System. While no payment is required at the doctor’s office, Spanish healthcare is not really free: Various social security taxes deduct about 37% from the gross pay of resident workers. No one can opt out.

In Spain’s barren, white-walled waiting rooms, patients seeking a doctor’s appointment may sit for hours waiting for their number to pop up on a screen. Waiting for surgery is even more drastic. Nearly 850,000 Spaniards were on a surgery waitlist in 2024, up from 700,000 in 2022. The average wait time: 121 days.

After falling during a morning run in Seville and breaking his femoral neck—the bone joining his leg to his hip—Carey Owen, 65, was eligible for a hip replacement. But since that’s not considered emergency surgery in Spain, he faced a 7-10 day wait for the operation in the city’s public hospital.

Thankfully, as American expats in Spain, Owen and his wife had private health insurance. When they learned his likely wait time for surgery, the couple found a private ambulance to transfer Owen to a private hospital. There, he received surgery the following morning.

Many Spaniards pay for private insurance to avoid wait times. Last year, 28% of Spaniards used voluntary health insurance—a rate that has nearly doubled in the past decade.

Castaño’s wait for appropriate treatment wasn’t just frustrating. It was life-threatening. “I kept asking them to run some blood tests, but they did nothing,” Castaño said.

The private doctor ran tests immediately, she said. After seeing her blood work, the private medical team ordered a colonoscopy and diagnosed her with cancer the same day. (The Ministry of Health and Consumer Affairs in Andalusia said it could not comment on Castaño’s case due to patient privacy rules.)

Irene Ramiro, a 32-year-old primary care doctor in Castile-La Mancha, said expectations for public doctors in Spain are often unrealistic, especially when they see up to 70 patients in one eight-hour shift. When doctors are overworked or inexperienced, it’s easier to make mistakes or be dismissive of a patient’s symptoms, she noted.

Public doctors in Spain have protested their work conditions for years. One survey found over 84% of Spanish doctors say they are underpaid. An estimated 40% work a second job—often by treating patients in the private sector.

To fight its growing waitlists, Spain’s healthcare system is increasingly contracting with private hospitals for surgeries.

For example, Irene Rodriguez, 41, was originally set to wait 18 months for knee surgery. When a bad fall left her barely able to walk, she was bumped up the list and scheduled for surgery at a private hospital in Extremadura. The government paid for the 12,000-euro procedure.

Not everyone dislikes Spain’s public healthcare. Estefanía Aldea, 40, from Barcelona, is a fan: She said Spanish residents have access to “medical services that in any other situation would be very, very, very expensive, especially when you have a serious health issue.” After receiving what she described as excellent treatment during her two pregnancies and births, Aldea believes the system works very well, although she agrees long wait times are a problem.

The Spanish Association of Public Health and Healthcare has called for comprehensive reform to the public healthcare system. Among its recommendations: Make jobs more accessible to doctors, provide them with consistent training, raise pay rates, and keep hospital technologies up to date.

Sally Pipes, president and CEO of the California-based Pacific Research Institute, says longer wait times and health professional shortages are typical of government-run healthcare systems. Pipes suggested Spain “look to market-­based healthcare reforms” to help expand private coverage and make healthcare more accessible and innovative.

Meanwhile, the slow-moving system can make people like Castaño feel helpless. The National Health System did work with Castaño’s private doctor to cover her radiation and chemotherapy treatment: A bottle of 20 chemo capsules costs 200 euros, but Castaño paid nothing out of pocket.

Today, her cancer is in remission, though a side effect from treatment took away feeling in her hands and feet and left her disabled. She’s thankful for her private doctor, but her opinion of Spain’s public health system is blunt: “From what I’ve seen, it works quite badly.”