The Catalan health ministry defends the "healthy public-private collaboration" of the Catalan system against that of Madrid

BarcelonaThe standoff between the Spanish government and the Community of Madrid over the privatization of healthcare services escalated on Tuesday with the announcement of a draft national law to make public management of healthcare centers "preferred." This move comes in the wake of the scandal surrounding... Torrejón Hospitalin which economic profit was allegedly deliberately prioritized over patient care. The future law aims to make privatization "exceptional" and limited to those issues that the public healthcare system cannot address, a change that has sparked some concern in Catalonia: that it could be used to dismantle Catalonia's historic comprehensive public healthcare system (Siscat). However, the Minister of Health, Mónica García, has assured that this will not happen and, in fact, has cited the unique Catalan healthcare system as an example of "healthy public-private collaboration." The minister explained in statements to RNE that the law to prioritize public management of healthcare services seeks to curb "obscene" and "mercantile" practices in public-private models, and she specifically referred to the policies of the PP government in Madrid, which "forgets" to charge patients. She made these remarks in relation to the information published by Eldiario.esGarcía, who points out that Isabel Díaz Ayuso's government allegedly "forgave" 71 million euros to Quirón and Ribera Salud after they took on and treated its patients, clarified, "What we don't want is for patients and money from our public healthcare system to continue being diverted to private healthcare." García explained that this law doesn't limit the privatization of healthcare, but rather models "driven by speculative and commercial interests." "What the law says is that it will put an end to this public-private partnership that is predatory to our healthcare system; non-profit models, models that work, that are a healthy public-private partnership, can perfectly well be maintained," he argued, citing the Catalan model as an example.

Furthermore, he explained that the law also aims to prohibit "the entire theme park of toxic public-private partnerships present in the Community of Madrid," such as paying a fee to the construction company of the healthcare center for decades. "I want to put an end to the gravy train Ms. Ayuso has and I want to put an end to the misappropriation of public funds that exists in the Community of Madrid," he concluded. Along these lines, he stated that the PP's model allows "the private sector to parasitically enter" the healthcare system and take "a large slice of the pie that should be used to care for patients."

Two very different models

On Tuesday, some Catalan employers' associations expressed concern about the Spanish government's announcement, arguing that the Torrejón case should not be considered a systemic problem across the country. Now, however, the minister's clarification could calm the waters. Roser Fernández, CEO of La Unión, emphasizes that in Catalonia, the contracting of services is "structural," and Anna Zarzosa, director of the Catalan Association of Health Entities (ACES), defends it as a key model for reducing waiting lists. According to Francisco José María Sánchez, CEO of the Catalan Health and Social Consortium, the problem in Madrid is "the lack of control" over the concessions. In fact, in Madrid, the outsourcing of healthcare management plays a significant role: the system prioritizes concessions to private groups, and the administration pays a fixed annual fee based on the assigned population size. Therefore, the hospital receives the same amount of money regardless of the number of operations or diagnostic tests it performs. Furthermore, the managing companies are primarily large, for-profit groups. In contrast, in Catalonia, healthcare has historically been a hybrid system: public and private-public partnership centers coexist within the Siscat system—as is the case with two large hospitals like Hospital Clínic and Hospital Sant Pau, both in Barcelona—and the managers are usually entities or foundations with public participation from city councils or county councils.

Broadly speaking, the main difference between the Catalan and Madrid models lies in their contracting model: in Catalonia, the system focuses on achieving activity targets; that is, centers commit to performing a certain number of services, operations, and tests per year, and if they fail to meet these targets, they are penalized. Industry sources assert that this strategy is designed to reduce long waiting lists and prevent perverse incentives that could infringe upon patients' rights.