Spain's New Draft Law Aims to Reinforce Public Healthcare and Curb Privatization

Health Minister Mónica García announced on Tuesday the Council of Ministers' approval of the Draft Law on Public Management and Integrity of the National Health System (SNS). This regulation is designed to strengthen direct management as the preferred model in public healthcare while closing the door to privatization formulas, which the Executive claims have caused fragmentation, decreased institutional control, and transparency deficits. Minister García highlighted alarming instances within the National Health System, including scandals such as those involving Quirón, Ribera Salud, and scandals surrounding breast cancer screenings in Andalusia. These cases, she argued, have turned healthcare into a profit-driven enterprise rather than prioritizing public health. She assured that the new regulation aims to eradicate such issues. The proposed law represents a significant political and legal shift by repealing Law 15/1997, which permitted various forms of SNS management for decades but has been under scrutiny in recent months. The new regulation aims to create a coherent framework based on principles of universality, equity, transparency, and quality. One of the main points García announced is that public management will henceforth be the norm in hospitals, healthcare centers, and services. The ministry's direct management will hinge on three essential components: 1. The competent healthcare administration, 2. Institutional public sector entities, and 3. Healthcare consortia among public administrations. Conversely, indirect management, outsourcing, or concessions to private companies will become an exception, only applicable in instances where the government can justify that it cannot provide the service directly while ensuring sustainability, efficiency, continuity, and quality of care. Prior evaluations by public entities will be mandated to ensure these criteria are met. The draft law also introduces a precautionary measure for any indirect service provision. It calls for a mandatory evaluation procedure and a justification report, as well as evaluations from a technical committee comprised of healthcare experts and representatives from civil society. These reports will be published to enhance accountability. In the case of service concessions, a report from the National Evaluation Office will analyze the financial sustainability of the proposals. Moreover, the new regulation will eliminate mixed contracts that intertwine infrastructure and service provision. This change prevents private companies from constructing a hospital and managing its healthcare services simultaneously—an approach previously prevalent in public-private partnership projects, particularly in the Community of Madrid. The region's president, Isabel Díaz Ayuso, criticized the new law, claiming it threatens the efficient functioning of healthcare services in a region with a growing population and an aging demographic that poses significant challenges. In terms of control mechanisms, the draft law enhances the government's capabilities through renewed obligations for autonomous communities and the National Health Management Institute. It will enforce governance tools in healthcare centers, standard indicators for health and quality agreed upon in the Interterritorial Council, regular publication of contracting data, external audits, and measures to guard against conflicts of interest. Additionally, specific provisions will support administrations looking to revert privatized services, with a technical advisory mechanism involving the Ministry of Health's High Inspection. An expert evaluation report is expected within a year, reviewing privatized management's experience within the SNS since 1997. The Ministry of Health's justification for the reform leans heavily on both national and international evidence. Studies from 38 OECD countries suggest no evidence that privatization improves efficiency. In Spain's context, García noted that indirect management models, such as the Alzira model, produced poorer outcomes in metrics like avoidable hospitalizations and mortality rates associated with heart attacks and strokes compared to their public hospital counterparts. As for existing contracts under the new law, they will continue until their expiration, with the new regulation applying to future procedures. The draft also modifies the Public Sector Contracts Law to favor non-profit entities in the case of competitive ties. The announcement of the draft law coincided with several protests in Madrid, where thousands participated in rallies under the slogan 'Save Madrid's Public Healthcare for the Health of Everyone.' More than 100 groups and entities rallied to demand universal access, sustainability, and proper funding for public healthcare, aiming to halt ongoing privatization efforts and reclaim previously privatized services. Related Sources: • Source 1 • Source 2