Sánchez takes a step to limit privatization and infuriates Ayuso: "He wants to destroy Madrid's healthcare system"

MadridThe clash of models between the Spanish government and the Community of Madrid shows no signs of slowing, and this Tuesday it was healthcare that took center stage. Pedro Sánchez's administration took a first step to safeguard public healthcare and, as it had been warning, laid out in writing the path it intends to follow. The Council of Ministers approved in its first reading a draft bill on healthcare services that aims to "slam the door," in the words of Health Minister Mónica García, on the publicly funded and privatized model promoted by the People's Party (PP) during José María Aznar's term. The Catalan healthcare system's employers' associations have already announced that they will demand the protection of the "unique" nature of Catalonia's publicly funded model. The bill, therefore, represents a direct attack on the healthcare system championed by Isabel Díaz Ayuso in the Community of Madrid. In fact, the president of the Madrid region was quick to react, accusing the government of "wanting to destroy healthcare" in Madrid and leading it into a "revolution" so that "nothing works."

In this way, Ayuso defended the need for the Community of Madrid to maintain its model, which, in addition to public healthcare, also includes concessions to private companies. "What should we do? Eliminate the Jiménez Díaz Foundation? Tell patients they're making a mistake when they choose these types of hospitals?" she asked. "[Ayuso] protects and shields the system from the clutches of speculators and privatizers," retorted Minister García, who openly stated that she wants to avoid "obscene" cases like the Madrid concessions to Quirón and Ribera Salud. According to Ayuso, it's all part of Sánchez's "obsession" to go against her, even though, she said, there are also public-private partnerships in the healthcare sector in other places like Catalonia. In any case, this is the first proposal from the Spanish government. Once the executive branch completes its legislative process, the bill will go to Congress, where Sánchez will depend on the votes of the plurinational majority. He will also need the support of Junts and the PNV, who advocate for public-private partnerships across all sectors.

What does the draft bill say?

With the regulations drafted by the Moncloa Palace, the aim is to make public management "preferred" and privatization of services "exceptional" in those areas where public healthcare cannot be provided. "I want to make it clear that this law is not against non-profit models or healthy public-private partnerships. It places limits on models that take resources from public healthcare to fatten the coffers of certain companies," summarized García, who said that outsourcing will now have to take into account... The Spanish government's draft bill consolidates the direct management model as the preferred modality in the provision of public healthcare and repeals the 1997 law on new forms of healthcare system management approved by Aznar. According to EFE, in the Community of Madrid there are five publicly owned but privately managed hospitals, most of them granted to Quirón: the Jiménez Díaz Foundation (Madrid); The Rey Juan Carlos University Hospital (Móstoles); the Infanta Elena University Hospital (Valdemoro); and the Villalba General University Hospital (Collado Villalba), in addition to the Torrejón hospital, managed by Ribera Salud, which was the subject of controversy because some audio recordings were leaked, published by The CountryIn which the center's managers requested longer waiting lists to increase the company's profits. According to the Spanish government, the proliferation of public-private partnership models has led to fragmentation, a lack of transparency, and reduced institutional oversight.

Defense of the Catalan model

Some of the employers' associations in the Catalan healthcare system, such as La Unió and the Catalan Association of Healthcare Entities (ACES), have criticized the Spanish government's announcement, arguing that it goes against the Catalan model. According to Roser Fernández, director general of La Unió, the proposed draft law will create a "conflict of powers," since the decision on how to organize the provision of healthcare services falls to the autonomous communities, and in Catalonia, contracting out services is "structural." In fact, 65% of the public healthcare system in Catalonia is managed through contracting out services, so Fernández has already stated that they will request the necessary amendments to recognize the "uniqueness of the Catalan model," which she insists is very different from Madrid's. The president of ACES, Lluís Monset, went further, arguing that, apart from the Catalan model, there are "other models that can be just as good" and that what is needed is to focus on the quality of care and economic results. However, he believes that a law that addresses "issues from the last century" will not pass.

Other measures

However, the Council of Ministers has approved two other measures alongside this draft bill. One of them creates a legal framework that recognizes the role of patient organizations, their rights and responsibilities in all matters affecting the public health service, and therefore recognizes them as interlocutors with the General State Administration.

"The patients' voice is fundamental," García argued. The proposal that they be recognized interlocutors and, therefore, have a say in some decisions about the healthcare system comes after the breast cancer diagnosis scandal in Andalusia, also governed by the PP. By the end of 2025, the The Andalusian government admitted errors in the diagnoses and estimated that there would be at least 2,000women affected.

The other measure is a modification of the selective funding procedure for healthcare products sold in pharmacies to outpatients. The current regulations from 1996 are repealed, and a new framework for the funding and pricing of these products is established, adapting them to current needs and prioritizing criteria of efficiency, sustainability, and clinical value, as well as guaranteeing supply, the minister explained.