Are there differences in the health service
among provinces? - by Carmen Aguilar

85% of the health workers consider that there are notorious differences in the quality of the health services within regions, according to a survey carried out by Deloitte in 2014.

Organisms such as Federación de Asociaciones para la Defensa de la Sanidad Pública (FADSP) showed the differences among the 17 Comunidades Autónomas, whose parliaments are responsible for this service within its territories.

But Deloitte's claim refers, however, to the inequality in the health service among provinces in the same Comunidad Autónoma.

Is that true?

There are differences in the resources in the primary healthcare service within the region of Andalucía, according to government figures.

Granada stands out with the highest number of centres and the lowest ratio of people by healthcare centre. Workers in Jaén are, however, the less pressured, although Almería registered the best improvement in staff between 2009 and 2016.

The inequality in the health system is broader by 'health areas', smaller divisions by province.

For each centre located in Valle del Gualdalhorce, there are 9.5 in Metropolitano de Granada. And health workers from Costa del Sol attend 16.6 times more people than their colleagues from A.G.S. Norte de Huelva.

The analysis, carried out with information obtained by a Freedom of Information request, could only challenge the primary healthcare system.
Figures related to hospitals and consultants are, though, not broken-down by small divisions.
The Junta de Andalucía avoided making comments on this subject.

The inequality broken-down

According to official methodology, there are three parameters to assess the primary healthcare system: professionals, centres and frequency of attendance. This analysis is based on these three.

Fewer people by doctor in Jaén

The ratio of professionals is key to measure the resources in the primary healthcare system, according to health organisations. Jaén and Málaga stand out, then, as the main characters.

General practitioners (GP) from the last one have assigned 22.4% more population than those from Jaén. Regarding paediatricians and nurses, the pressure over those from Málaga is 40.5% and 34.6% higher, respectively, than those from the province of the olive oil, according to the official last figures from 2016.

Compared to 2009, the number of citizens per nurse and paediatrician decreased in all the provinces; although the drops vary from 9.7% in the nurse ratio in Granada and 1% in the one of paediatrics in Huelva and Sevilla.

Source: Spanish Health Ministry

The diminution in the paediatrics rate "is due to the decrease of the natality and the crisis -migrants stop arriving and young people left the country", explains Marciano Sánchez Bayle, the president of the Federación de Asociaciones por la Defensa de la Sanidad Pública (FADSP) de Madrid.

FADSP establishes advisable ratios per professional. 1,500 people by GP and nurse and 1,200 by paediatrician. And Málaga and Jaén repeat position again.

The first one is over the rate in all the three categories; while Jaén meets all the advisable ratios. This is also the only province whose nurses do not care for more than 1,500 people.

Seven out of eight suffer from nurse shortage

"The nurse situation is due to (a lack of) resources", says Marciano Sánchez, "because the population hasn't changed much during these seven years".

Between 2009 and 2016, the number of nurses increased in all the eight provinces, although the growth has only been enough to meet the recommended proportion of people in Jaén.

There have been, however, differences in the improvement of the staff. Almería increased by 10% the number of nurses and paediatricians. Cádiz nurses enhanced by only 2.5%; while Jaén lost 2% in paediatrics.

Source: Spanish Health Ministry

Centres from Granada the least crowded

Granada had the highest number of healthcare centres in 2016. 330 versus 126 in Huelva, the area with the lowest one. For each 'onubense' centre, there were 2.6 centres in Granada.

But there are two types of centres: the health centre and the doctor's office. Both fulfil the same role, but the first type has more resources than the latter.

And Granada is once more at the top of the list. The city has 3.6 times more doctor's offices (278) than Cádiz (77); while the inequality in health centres is 3 to 1 between Sevilla (86) and Huelva (29).

Source: Spanish Health Ministry

The city of La Alhambra is also at the head of the ratio of centres per population, with the lowest number of people by centre (regardless type). Huelva, on the contrary, is the worst, with 6.8 times more population by centre than Granada.

"Some areas, though, need to have a minimum number of centres and workers to guarantee the medical care, what can explain some of the difference", Sánchez Bayle says.

The density of population and the age and the socioeconomic rates might be behind those numbers. Rural areas, with fewer and elderly citizens "need more health care", the FADSP president says. And the accessibility in those zones is poorer than in urban areas, while the medical attendance should be secured, as he insists.

Select the parameter and click on the map to see the local information. Better display on computer.

Source: Instituto de Estadística y Cartografía de Andalucía

'Malagueños', who visit the doctor the least

People from Jaén go more often to the healthcare centre than any other province. However, each 'jiennense' visited the doctor on average 6.7 times in 2016, only 1.7 more times than the 'malagueños' (5), who registered the lowest rate.

Málaga also has the lowest number in regards to emergency frequency. Each person used that service 0.6 times per year, while Huelva duplicated the figure (1.3) during 2016.

The frequency in emergency rose between 2012 and 2016 in all the provinces. The biggest increase occurred in Huelva (0.16) and the smallest in Jaén (0.04)

However, the general frequency fell in all the eight divisions between 2009 and 2016. The drop, though, varies from 1.7 points in Granada to 0.2 in Málaga.

Source: Spanish Health Ministry

Would you like details about your area?

Zoom to look for your town or village and click to see the name of your health area

Source: Spanish Health Ministry

Bigger inequality among health areas

Health Ministry divides each province into several smaller divisions called "Áreas de Salud". And the inequality widens among those areas.

According to the governmental figures analysed, the health workforce from Costa del Sol is the most pressured.

Click to compare your health area by each parameter.

Source: Spanish Health Ministry

General practitioners in this area has been assigned 74.6% more citizens than those from A. G. S. Nordeste de Granada. Nurses assist 140.4% more people than their colleagues from A.G.S. Norte de Huelva. And the pressure over paediatricians is 176% higher than the professionals in the same 'onubense' health area.

Almost 11 out of 15 health areas have more people than the advisable ratio in nurses (1,500 people/nurse), while one out of six doesn't meet the criteria on paediatrics (1,200 people/paediatrician) and almost one out of three exceeds the GP one (1,500 people/GP).

Click to compare your health area by each parameter.

Source: Spanish Health Ministry

The same area, Costa del Sol, has the most crowded centres, with 16.6 times more people than those from A.G.S. Norte de Huelva.

Regarding quantity of centres, Metropolitano de Granada has 9.5 primary healthcare centres for each one located in Valle del Guadalhorce.

Click to compare your health area by each parameter.

Source: Spanish Health Ministry

And, again, Costa del Sol is one of the main characters in the frequency parameter.

People from this area went to the doctor 4.4 times in 2016, the lowest rate in Andalucía. A.G.S. Nordeste de Granada, however, led the general frequency with 7.53 times in that year.

Regarding the frequency in A&E in non-hospital units, citizens from Norte de Almería went 1.89, while Málaga reached 0.16 times in 2016.

People are preferring the emergency service versus the general one. The rate of the first one went up in the last four years, while the general frequency decreased between 2009 and 2016.

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