The Catalan healthcare model is not to be touched.
There are laws that regulate. And some that redefine entire models. The Draft Bill on Public Management and Integrity of the National Health System, approved in its first reading by the Council of Ministers on February 10, falls into this second category. And when models are redefined, it is essential to be extraordinarily precise: not everything is the same. Not all forms of public-private partnerships are equal. Not all respond to the same incentives. And not all generate the same impacts on the public health system.
When there are controversies surrounding healthcare contracts, judicial investigations, or suspicions of malpractice—as has happened in the Community of Madrid—the political response is usually immediate: more regulation, more control, more restrictions. This is understandable. The integrity of the healthcare system is a collective good to be protected. But legislating based on specific dysfunctions without distinguishing between realities can end up creating a problem where none exists. In Catalonia, the healthcare system has been built, to a large extent, on the foundation of non-profit entities, deeply rooted in the territory and structurally integrated into the public network. The Catalan model has not been built on commercial concessions; it is neither concessionary nor speculative: we are talking about agreements with non-profit entities as a model for managing a public service, a proven and recognized formula for success. And this difference is not rhetorical; it is structural and has become key to structuring a fundamental pillar of our welfare state.
A structural part of the system. Health foundations are not a complement to the Catalan healthcare system. They are a central component. They contribute between one-fifth and one-third of healthcare resources and employ more than one-third of public healthcare professionals. We are talking about emergency services, hospital discharges, beds, and operating rooms. We are talking about real capacity for care, for services to people.
Without hospital foundations, seven Catalan counties – Alt Empordà, Baix Empordà, Garrotxa, Ripollès, Bages, Vallès Oriental, and Alt Urgell – would be left without a referral hospital. This is the territorial dimension of the debate.
Behind this model are institutions with deep roots and a long history, such as the Fundació Hospital de la Santa Creu i Sant Pau, with more than six centuries of history; The Mollet Health Foundation and the Santa Tecla Social and Healthcare Foundation, essential for local healthcare; the Puigvert Foundation, a leader in urology; and the Sant Joan de Déu Foundation for Research and Teaching, a driving force in pediatric research and innovation. These are examples of a model that combines public service, quality care, and social commitment.
These entities reinvest all surpluses in infrastructure, equipment, research, and improved care. They are private entities that are part of the public system because they provide a public service, and they do so with obligations of governance, transparency, and oversight. And they do not, under any circumstances, distribute profits. To confuse the Catalan healthcare model with purely speculative formulas or purely commercial concession schemes would be a diagnostic error with real consequences.
Regular, yes, but rigorous. Catalonia is a country with a strong organized civil society. In the healthcare sector, this tradition has deep roots: many hospital foundations were created to meet social needs when the government couldn't reach everyone, and over time they became fully integrated into the public network. This model has been developed since 1990 under the Catalan Healthcare Organization Act (LOSC), with evaluation, contracting, and control systems that have guaranteed quality and results. It is neither an improvised nor an opaque model. Even the Minister of Health has publicly recognized the Catalan model as a "sound" formula, distinct from those of other regions. At the Catalan Foundations Coordinator, we share the objective of strengthening integrity and transparency. However, we warn of a risk: that regulations designed to correct abuses in certain concession schemes could end up creating legal uncertainty about a model that works. The draft bill must clearly differentiate between for-profit commercial management and non-profit management integrated into the public network; it must prevent measures designed to curb dysfunctions from ultimately affecting agreements with entities that strive for the common good and are non-profit; and it must guarantee regulatory stability so that the system can plan investments and resources with certainty.
600 kilometers, two models of healthcare. When we defend healthcare foundations, we are not defending privileges. We are defending a social economy model applied to public healthcare, territorial cohesion, and full reinvestment in health. Catalan healthcare is the result of decades of collective commitment between institutions and society. It is a guarantee for thousands of professionals and for millions of people who entrust their health to them every day.
Between Barcelona and Madrid there are just over 600 kilometers, but in terms of healthcare models, the distance is much greater: what works, what is deeply rooted, and what puts people at the center deserves to be preserved. Not out of territorial pride, although that is part of it, but out of responsibility to the country. Catalonia, a land of foundations.