- AIReF finds that the system has expanded over recent decades, but also identifies structural challenges affecting its efficiency and effectiveness—such as insularity—and puts forward proposals to address them.
- It finds that the regulatory framework is fragmented, which limits management capacity, and therefore proposes reviewing and further developing the regional framework to give healthcare centres greater organisational flexibility.
- It identifies mismatches between funded and filled posts, together with considerable territorial disparities, and therefore recommends introducing a dynamic planning model based on demographic projections and real-time monitoring systems.
- It proposes measures such as telemedicine, agenda optimisation and inter-island referrals to improve indicators of pressure on primary care services.
- It also proposes moving towards a more flexible incentive model, linked to performance and adapted to territorial needs.
The Independent Authority for Fiscal Responsibility (AIReF) today published its assessment of human resources policy in the public healthcare system of the Balearic Islands, which finds that both the budget and the workforce have grown over recent decades, with a relatively greater effort than in the National Health System as a whole. However, the analysis also identifies structural challenges affecting the system’s efficiency and effectiveness, and therefore sets out a series of proposals for improvement.
AIReF points to factors such as insularity, which adds complexity to logistics and to the management of human resources, regulatory fragmentation, and territorial differences in staffing levels. The study identifies these critical areas and sets out a package of proposals aimed at modernising management, optimising the use of public resources, and ensuring high-quality healthcare.
From a regulatory perspective, human resources policy in the Balearic Islands’ healthcare system is based on the Framework Statute and the Basic Statute for Public Employees, with no significant regional regulatory developments. Although non-permanent staff have been eliminated and interim contracts have been consolidated with a maximum duration of three years, significant regulatory fragmentation persists, and recruitment processes are still largely based on traditional criteria. According to AIReF, the limited autonomy of healthcare centres and the high degree of regulation hinder agile and efficient workforce management, and it therefore proposes reviewing and developing the regional regulatory framework to give healthcare centres greater organisational and management flexibility.
Healthcare supply and demand
AIReF finds that IB-SALUT had 18,673 professionals in 2023, with significant growth in primary care and some relative improvement in territorial allocation. Even so, the staffing ratio remains below the national average, pointing to significant mismatches between funded and filled posts, as well as disparities between basic health zones. It therefore proposes introducing a dynamic, territorial planning model that incorporates demographic projections, demand trends and staffing needs in order to reduce these mismatches. The model would include coverage risk maps and real-time monitoring systems to anticipate critical situations in vulnerable areas.
Indicators of pressure on primary care services point to considerable scope for improvement, particularly in primary care, where in 2023 the daily average stood at 30.2 patients per family doctor, rising to 40 in some areas. Average waiting time reached 6.2 days, and more than 80% of patient caseloads exceeded the recommended 48-hour threshold. No direct correlation is observed between healthcare pressure and population density, but there is marked internal variation and a seasonal pattern suggesting the need for additional capacity during periods of heavier demand. In this context, AIReF proposes developing a strategy to optimise both care capacity and demand management, with a particular focus on those patient caseloads and services showing the weakest indicators for healthcare pressure and waiting times. This strategy would include measures such as telemedicine, extended opening hours, agenda optimisation and inter-island referrals, together with a territorial monitoring system.
Temporary employment and the pay system
The study finds that temporary employment remains a structural characteristic of healthcare employment, particularly in primary care. In the Balearic Islands, 49% of staff were on temporary contracts in 2023, and 18% of them were employed on temporary replacement contracts. Since 2015, eleven public employment offers have been launched, covering 3,902 posts, along with six transfer rounds since 2018. These measures have helped to contain temporary employment to some extent, but their impact has varied across categories and territories. In view of this situation, AIReF proposes strengthening workforce planning for public employment offers by establishing a predictable timetable to reduce temporary employment in a sustained and targeted way in the areas most affected, together with strategic criteria for allocation and post-recruitment follow-up, as well as retention incentives for hard-to-fill areas. This strategy would include prioritising posts with high turnover, improving coordination between public employment offers and transfers, using predictive analysis of staffing needs, and introducing incentive schemes to maximise the effectiveness of workforce planning tools.
Lastly, as regards the pay and incentives system, AIReF finds that state-level regulation remains dominant. There are some specific standalone agreements on productivity, hard-to-fill posts and continuity of care, but they are limited in scope and fragmented. Although a career progression system is in place, it is based mainly on length of service, and the retention supplements applied in Ibiza, Formentera and Menorca lack a consistent regulatory framework. In addition, the limited autonomy of healthcare centres in managing incentives significantly restricts stable staffing in island posts. Against this backdrop, AIReF proposes promoting the development of a system that enhances motivation, recognises performance and supports the filling of strategic posts across the territory. This model would integrate all pay components linked to performance, continuity of care and career progression, giving centres greater flexibility to manage incentives tailored to territorial needs, with a particular focus on retention in hard-to-fill areas.
