Healthcare models: Madrid vs. Catalonia
The scandal in the Torrejón de Ardoz Hospital as a result of some audio recordings revealed byThe Country This has provoked profound outrage. In the recordings, the CEO of the private group Ribera Salud—which manages the public hospital under a concession agreement—can be heard giving explicit orders to increase waiting lists by rejecting patients and tests that are not profitable. The case involves alleged malpractice by the Madrid hospital, which may have endangered patients by prioritizing profit over the fundamental right to health. The understandable concerns extend far beyond the hospital's users. Distrust permeates the entire healthcare privatization model implemented decades ago in the Community of Madrid, a model that originated precisely with what the same Ribera group began doing in the Valencian Community in the 1990s. The model is based on concessions to private groups to which the regional government pays a fixed annual fee based on population. In short: the hospital receives the same amount of money regardless of the number of operations or diagnostic tests it performs. The potential problems with this healthcare approach have now become very clear in Torrejón de Ardoz, but the Minister of Health herself, Mónica García, has warned that "it is not an isolated case." It is inevitable to wonder where the original sin lies that has allowed this situation to arise, or if something like this could happen in our country, where the healthcare model is based on a robust public network but also includes an essential role for private entities. The major difference with Madrid lies in the contracting model, in how and with whom this public-private collaboration is structured, and in the guarantees and controls that the administration must exercise to preserve equity and the common good.
The contracts between Catalan healthcare centers and the public administration are not only, in the case of hospitals, mostly with non-profit entities or foundations with public participation from municipalities or regional councils, but are also focused on achieving specific activity targets. Hospitals commit to performing a certain number of services, operations, or tests per year. Everything is therefore focused on reducing waiting lists—still unacceptably long, let's remember—and preventing any perverse incentives that could ultimately violate patients' rights.
This unique contracting model has become one of the healthcare system's greatest strengths, and therefore, preserving and protecting it from companies primarily focused on distributing dividends to shareholders must be a priority. However, recognizing the value of the current model does not mean ignoring its risks, and therefore, two fundamental principles must be upheld: transparency and accountability.
Furthermore, being far removed from Ayuso's privatization model should not make us lose sight of the challenges facing Catalan healthcare, where the extremely high pressure on staff (not only in hospitals but also in primary care centers, as we see these days with the flu epidemic) is compounded by inadequate remuneration.
