The cost of a publicly owned hospital built and managed by a private company is between seven and eight times higher than one built and managed by the public. In the case of a center built with public money and privately managed, the extra cost is multiplied by 11. This is one of the results that the second report on the ‘diagnosis of health and the health system of the Community of Madrid’. In it, it also warns of a “critical situation” of public health in the region, fifteen years after the start of the privatization process launched by Esperanza Aguirre and after which “there is no evidence of improvement in health care ”.
The report, prepared by the CCOO of Madrid and the Association for the Defense of Public Health, analyzes how the health system as a whole has evolved. In the section dedicated to healthcare privatization, these organizations focus on the fact that the opening of 13 new hospitals in the region, which the successive Executives of the Popular Party boast to this day, has not translated into an increase in the number of beds per 1,000 inhabitants. On the contrary, if in 2010 there were 3.37 per thousand citizens, in 2020 there were 3.09. A fact, they say, that “is due in part to the parallel closure of beds in pre-existing hospitals.” Specifically, beds in public centers have been reduced from 2.29 to 2.05 per 1,000 inhabitants in a decade.
The report also states that there is a “systematic deterioration of traditional management centers, especially those closest to the new centers” and a “transfer of patients to privatized centers.” In addition, it ensures that the health crisis derived from covid-19 has been “taken advantage of” by the Community of Madrid to increase privatizations in vaccinations, hospitalizations, trackers and purchases in an “uncontrolled” way and “in more than one case with suspicions of corruption ”.
The waiting lists to undergo an operation in the Community of Madrid is another of the parameters that point to a deterioration in health care. In June 2005 there were 27,672 people waiting for surgery. In March 2022 it had multiplied by three, to 90,317 people.
In addition to the cost overruns of public-private partnership models, the report notes that “there are numerous detected cases of extra-budgetary and/or irregular contributions of public funding to these centers.” For this reason, they require an audit by the health inspection and the Court of Auditors. Precisely, the Chamber of Accounts has already pointed out on several occasions the lack of control and the lack of effectiveness of the concession system in hospitals in the region. The supervisory body noted increases over what was budgeted from the public coffers and treatments up to six times more expensive in some of these hospitals. The work carried out by the union and the federation points to the absence of “public control over the operation of these centers and the fulfillment of contracts.”
In the financing chapter, the Community of Madrid is one of those that is at the bottom, both in spending per inhabitant and in terms of GDP. In the first case it is in the penultimate position, with 1,340 euros; in the second, it closes the list, with 3.7% of the total. In addition, it is the public part that has suffered the cuts in the worst moments, such as the economic crisis of 2008, while the private companies with which the administration has closed contracts have not suffered a decrease in the amounts of their contracts.
In a decade, between 2009 and 2019, the salaried staff of the Madrid Health Service was reduced by almost 2,000 professionals, to stand at 73,570 personnel. This figure has increased again in 2020 and, despite a slight drop, 2021 closed with 83,480 workers. An increase that the report attributes to the needs of the coronavirus pandemic. This situation caused the 2019 budgets to have to be modified upwards, extended for two years due to the inability of the first Ayuso government to approve new ones. That year, 2,615 million euros were added to the 7,662 planned. “This increase is due, above all, to the extraordinary contributions from the central government through the COVID-19 Fund, which according to the Ministry itself would have been 2,163 million,” the report states.
“Continuous mistreatment of Primary Care”
The study also emphasizes the “continuous mistreatment suffered by Primary Care”, which was already “overwhelmed before the explosion of the virus”. “In Madrid it has the largest number of users assigned by family doctor, paediatrician, nursing and administrative professional in all of Spain. While the population grows, the workforce has been decreasing with less than one medical or nursing professional for every thousand inhabitants, estimating that there is a deficit of 2,000 nursing and family medicine professionals”, they explain.
Along the same lines, the report concludes that “the Public Health of the Community of Madrid needs a firm commitment to a public model of direct management, based on an agreed Public Health Plan, which equitably addresses the health needs of citizens and citizens and that provides sufficient resources for the development and improvement of its quality, in addition to ensuring the future of health professionals, providing them with the necessary means. In short, a model that puts an end to the mercantilist and privatizing objective of the regional government”, the authors denounce.
Specifically, these organizations quantify an extra 3,000 million euros –up to 11,312–, 3,100 more professionals and reaching five beds for every 1,000 inhabitants, the necessary resources for the Community to equal the national average. With these data, the general secretary of the CCOO of Madrid, Paloma López, has lamented the “immobility” and the “lack of commitment” of the Government of Ayuso, pointing out that the recommendations of this second report are the same as those made in the first, in 2019.