Spain’s Minister of Health, Mónica García, presented a draft law to the Council of Ministers on Tuesday aimed at preventing the outsourcing of management of public hospitals without justification or oversight. García described the move as “a triumph for civil society,” asserting it will protect the National Health System from “speculative and privatizing claws.”
The proposed legislation comes as private healthcare companies already manage one in three hospitals within Spain’s public network. García cited examples of cost-cutting measures allegedly implemented by private managers, referencing statements made by the CEO of Ribera Salud to hospital directors in Torrejón. She accused some groups of practices such as scheduling appointments at 4 a.m. To maximize revenue from waiting lists, and alleged that organizations like Quirón have increased the number of patients drawn from the public system in Madrid by a factor of six.
“This law puts an end to this drift, closes the chapter of the 1997 law – a law of Aznar – that allowed profit to enter public management,” García stated, emphasizing that the recent bill establishes direct public management as the preferred model. Indirect management, she explained, will be limited to exceptional cases where it can be demonstrated that public management lacks the capacity to deliver. “It will not be possible to resort to it capriciously, ideologically, or as it is an inherited model,” she added.
The draft law, formally titled the “Law on Public Management and Integrity of the National Health System,” mandates that any autonomous community seeking to outsource hospital management must first undergo a preliminary evaluation. Communities will be required to submit a report justifying the need for privatization, which will then be reviewed by a committee of experts and technicians.
Under the proposed rules, outsourcing will only be permitted when direct provision is not feasible, provided financial sustainability and quality, continuity, accessibility, and affordability of service are guaranteed. These justifications, outlined in the autonomous communities’ reports, will be made public.
The legislation also prioritizes agreements with non-profit organizations over for-profit companies, effectively aiming to limit the influence of groups like Quirón and Ribera Salud, which specialize in the private management of public hospitals.
Alongside the healthcare privatization bill, the Ministry also approved a draft law concerning patient organizations. This legislation, a first for Spain, formally recognizes the unique legal status and crucial role of these organizations as advocates for the rights and interests of patients, families, and caregivers. The draft law guarantees their participation in the governance structures of the National Health System, defines their rights, and proposes the creation of a National Registry of Patient Organizations.
the Ministry approved a royal decree regulating the financing procedure for health products within the pharmaceutical benefit system. The decree updates and establishes criteria for the inclusion, modification, and exclusion of health products, stipulating that only serially produced products with a European Union seal, not subject to advertising, and requiring a medical prescription will be funded. The National Health System will evaluate products before covering them.
The Ministry asserts that the decree “unlocks an existing and long-unaddressed situation, allowing the incorporation of new suppliers and health products into the pharmaceutical benefit system,” and will require companies to guarantee the supply of these products.