Article 3.2 of Law 14/1986, of 25 April, General of Health, points out that access and health benefits will be carried out under conditions of effective equality. This provision is only the application in the health field of the right to equality recognized in Article 14 of the Constitution, the effective implementation of which must promote public authorities, corresponding to the State the regulation of basic conditions to ensure such equality when fundamental rights are at stake.

For their part, Law 16/2003, of 28 May, of cohesion and quality of the National Health System, regulates the health benefits and essential aspects of the same, as are the references to guarantees of accessibility, mobility, access time, information, security and quality. The cooperation of public health administrations is a means to assure citizens of the right to health protection, with the aim of guaranteeing equity, in line with the development of the constitutional principle of equality, to ensure access to benefits and in this way the right to health protection under conditions of effective equality throughout the territory.

This law provides in its article 4 that citizens ' rights in the whole of the National Health System receive healthcare in their autonomous community of residence in a maximum time in the terms collected in the Article 25, as well as to receive, by the health service of the autonomous community in which it is displaced, the health care of the catalogue of benefits of the National Health System that may require, under the same conditions and identical guarantees that citizens resident in that autonomous community.

Likewise, in its article 23, when regulating the guarantee of accessibility, it points out that all users of the National Health System will have access to health benefits under conditions of effective equality.

For its part, Article 25 establishes the time guarantees, providing that within the Interterritorial Council the framework criteria will be agreed to guarantee a maximum time of access to the benefits of the National System Health, which will be approved by royal decree. The Autonomous Communities will define the maximum access times for their service portfolio within that framework. Finally, in its article 71, which defines the functions of the Interterritorial Council of the National Health System, it indicates that the latter will discuss, discuss and, if necessary, issue recommendations on the framework criteria to guarantee a maximum access to the benefits of the National Health System.

The content of health benefits is regulated by Royal Decree 1030/2006 of 15 September establishing the portfolio of common services of the National Health System and the procedure for its updating, in which Article 2.3 it is envisaged that the procedure for access to services which render the benefits effective will be determined by the health administrations in the field of their respective competences.

On the other hand, by Royal Decree 605/2003 of 23 May, establishing measures for the homogeneous treatment of information on waiting lists in the National Health System, the system was implemented information for waiting lists. After the time since publication, it is considered appropriate to regulate the guarantees of maximum access times.

In the development of the provisions of Law 16/2003 of May 28, this royal decree defines the framework criteria to guarantee maximum access to the benefits of the National Health System.

This rule has a legal nature of basic and common legislation in terms of guarantees of maximum access times for the entire National Health System and its elaboration has been carried out with an active participation of the The Committee of the National Health System, which was the subject of the text that was the subject of the agreement at the plenary session, held that the autonomous communities, within the Commission of Benefits, Assurance and Financing, were dependent on the Interterritorial Council of the National Health System. October 18, 2010. In dealing with this rule, it has also been subject to consultation of the sectors concerned and the Consumer and Users ' Council.

In its virtue, on the proposal of the Minister of Health, Social Policy and Equality, with the prior approval of the Third Vice President of the Government and Minister of Territorial Policy and Public Administration, according to the Council of State and prior deliberation of the Council of Ministers at its meeting on 15 July 2011,

DISPONGO:

Article 1. Object.

In application of the provisions of Law 16/2003, of 28 May, of cohesion and quality of the National Health System, this royal decree aims to establish the framework criteria to guarantee users of the National System (a) maximum time for access to health benefits, so that such access can be carried out under conditions of effective equality.

Article 2. Scope.

1. Beneficiaries of the guarantee established in this royal decree, the holders of the rights to the protection of health and health care referred to in article 3.1 of Law 16/2003, of 28 May, of cohesion and quality of the System National of Health, for those benefits included in the portfolio of services regulated by Royal Decree 1030/2006, of 15 September, establishing the portfolio of common services of the National Health System and the procedure for updating, and its implementing rules, as set out in the Annex.

2. They are excluded from the scope of this royal decree:

(a) Surgical interventions for organ and tissue transplants, the performance of which will depend on the availability of organs, as well as health care in the event of a disaster, in accordance with the provisions of the Article 25 (2) of Law 16/2003 of 28 May.

b) Interventions that may require a wait to gather the right conditions for their realization, as is the case with those related to assisted human reproduction techniques.

c) Emergency health care, including limb reimplants and burn care.

d) Health care not included in the service portfolio of the National System of Health regulated in Royal Decree 1030/2006, of September 15.

Article 3. Definitions.

For the purposes of this royal decree, the definitions set out in Annexes I and II to Royal Decree 605/2003 of 23 May 2003 laying down measures for the homogeneous treatment of information on the waiting lists in the National Health System. In addition,

following definitions shall apply:

1. Maximum access time: Time limit, expressed in calendar days, that cannot be exceeded to intervene surgically, attend to external consultations or perform a diagnostic or therapeutic test on a user of the National Health System. That period shall be computed from the moment of the indication of the care by the optional, which shall correspond to the date of entry into the waiting register.

2. Guarantee of maximum access time: Commitment acquired by the health service of the corresponding autonomous community that involves attending to the user with the appropriate quality conditions, within the maximum access time established in his/her scope, which in no case will exceed what was foreseen in this royal decree.

3. Loss of warranty: A situation that causes the guarantee of the maximum access time by the corresponding health service to be left without effect for a certain user.

4. Suspension of the guarantee: Interim situation in which the guarantee of the maximum access time by the corresponding health service is suspended on a transitional basis and as long as the reasons for such a situation persist.

Article 4. Framework criteria to ensure maximum access times.

1. The maximum access times, guaranteed to all users of the National Health System, are included in the Annex for the performance of certain surgical interventions that have been selected by applying the following criteria:

a) Gravity of the pathologies of the attention: Pathologies that in their later evolution lead to risk of death or disability or decrease in an important way the quality of life.

b) Effectiveness of intervention: Surgical intervention is effective in increasing survival, decreasing disability, or improving the quality of life of the user.

c) Opportunity of intervention: Its early realization prevents progression of the disease or its sequelae.

2. The health services of the autonomous communities will concretize in their territorial scope the guarantees provided for in this royal decree, establishing maximum access times for programmable health care. For this purpose, they shall use as a reference the maximum times set out in the Annex and take into account whether the processes or pathologies to which the interventions are addressed have a special impact on the health or quality of life of the user.

3. The maximum access times set out in the annex to this royal decree will be monitored through the information system regulated in Royal Decree 605/2003 of 23 May, which sets out measures for the treatment of Homogeneous information on waiting lists in the National Health System.

Article 5. Exercise of the guarantee.

1. The guarantee of maximum access time provided for in this royal decree refers only to the health care for which the user would have been included in the waiting list record. Consequently, this guarantee shall not cover any other health care other than that which originated such registration.

2. In order to guarantee the maximum access to the health benefits to which this royal decree refers, the health services of the autonomous communities will establish the necessary mechanisms to provide adequate care. health to users.

3. To this end, the health services will offer the user the alternatives that they consider most appropriate for the effective realization of the guaranteed care.

4. This guarantee may, however, be suspended or suspended for reasons attributable to the user, in accordance with the provisions of Article 6.

Article 6. Loss and suspension of warranty.

1. The maximum access time warranty will be without effect when the user:

a) stop having the indication that warranted guaranteed care.

b) voluntarily give up guaranteed care.

(c) have not, within the time limit set for this purpose, opted for any of the alternatives offered by the health service or would have rejected the alternative/s centre/s for the performance of the assistance.

d) do not present, without justification, the corresponding citation in the center that offers the health service.

e) delay care without justified cause.

(f) fails to comply with any of the obligations referred to in Article 7 (a), (b) and (d).

2. However, in assumptions (c), (e) and (f) of the previous paragraph, the user will continue in the waiting list record, even if he loses the warranty for that attention.

3. A suspension of the guarantee, which will result in the interruption of the calculation of the maximum time limits, shall occur in the following cases:

(a) When the user requests a deferral of the guaranteed care for a given time, without giving up the same, and provided that he claims duly justified causes, such as birth or adoption of child, marriage, death or serious illness of a family member or the fulfilment of an inexcusable duty of a personal nature during the days which are indispensable to assist him.

b) When there is clinical cause to justify the postponement of the care process.

c) In the event of catastrophic events, epidemics, strikes or serious dysfunctions affecting one or more health centres or services.

4. The calculation of the maximum access time shall be resumed once the circumstances that have caused the interruption of the deadline have been removed.

Article 7. User obligations.

In order for the maximum access time guarantee provided in this royal decree to be effective, users enrolled in the wait log are required to:

(a) Keep data on your phone, address, or e-mail, for the purposes of appeal, notification, or location by the health service.

(b) Justify, when personal reasons are present, and by means of the procedure that the health service to that effect determines, the request for deferment of the guaranteed care.

c) Communicate in good time, whenever possible, the decision not to appear for a summons.

d) Provide the health service with the necessary information required for it to be able to provide the health service with the most appropriate alternative for the provision of guaranteed care.

(e) to bring to the attention of those responsible for health institutions the irregularities which they observe in the exercise of the right to guarantee maximum access time, by means of the procedure provided by the health service set for that purpose.

Article 8. Updating access maximum times.

1. Subject to the agreement of the Interterritorial Council of the National Health System, the maximum access times set out in the Annex may be reviewed periodically, in order to adapt them to the health situation of each moment, to the situation Socioeconomic and user needs of the National Health System.

2. In addition, and with the agreement of the Interterritorial Council, maximum access times for the first external consultation of specialized care and for diagnostic or therapeutic tests shall be included in the Annex, applying the same criteria. referred to in Article 4.1 for surgical interventions.

Single additional disposition. Guarantees of maximum access times in the benefits provided by the National Institute of Health Management and by the Mutualities of Officials.

The guarantees established in this royal decree will also apply to the assistance provided by the National Institute of Health Management and by the General Mutuality of Civil Servants of the State (MUFACE), the Social Institute of the Armed Forces (ISFAS) and the General Judicial Mutuality (MUGEJU).

Transitional disposition. Period of adaptation.

The autonomous communities will have six months to adapt their regulations to what is foreseen in this royal decree.

Final disposition first. Competence title.

This royal decree is issued in accordance with the provisions of Article 149.1.16 of the Constitution, which gives the State exclusive competence in the field of basic and general health coordination.

Final disposition second. Regulatory enablement.

The head of the Ministry of Health, Social Policy and Equality is empowered to develop the provisions of this royal decree and, in particular, to implement it in the management of the National Institute of Management. Health.

Final disposition third. Entry into force.

This royal decree will enter into force on the day following its publication in the "Official State Gazette".

Given in Madrid, July 15, 2011.

JOHN CARLOS R.

The Minister of Health, Social Policy, and Equality

LEIRE PAJIN IRALA

ANNEX

Maximum access times guaranteed to users of the National Health System

180

180

knee

Surgical Interventions	Maximum access time (calendar days)
Valvular heart surgery	180
heart surgery	180
	Falls		180
	180
180