Waiting Lists in Healthcare: Spain–France | A Comparative Analysis of Access

Description

Waiting lists are among the most visible indicators used to assess the performance of public healthcare systems. However, when analyzed in isolation, they offer a limited and sometimes misleading understanding of real access to healthcare.

This document provides a comparative analysis of Spain and France to address a central question:
Are waiting lists a problem in themselves, or are they the consequence of how access to healthcare is organized and managed?

Through an examination of the data published in both countries and the way access difficulties are measured and governed, the analysis shows that the volume of patients awaiting care is best understood as the result of a dynamic balance between demand, capacity and care resolution, rather than as an autonomous management variable.

Spain has developed a robust and transparent system for publishing waiting list data, which constitutes an international benchmark in terms of comparability and accountability. France, by contrast, has historically focused on access times, territorial organization and care pathways, without constructing aggregated waiting lists as a central management instrument. This difference in approach reveals two distinct ways of understanding and governing access to healthcare.

From the conceptual framework of the Venturi Project, the document argues that effective access management cannot be achieved by acting on the final figures alone. Instead, it requires analyzing and governing the processes that regulate system inflows and outflows, including indications, consultations, diagnoses, interventions and alternative care pathways.

This analysis is intended for healthcare leaders, managers, public decision-makers and professionals seeking a more operational, structural and sustainable understanding of access to healthcare, beyond the mere publication of waiting list figures.