This morning, in Madrid, I attended the launch of the book “Colaboración público-privada en sanidad: el Modelo Alzira” (Public-private partnership in health: the Alzira Model). This book, which aims to analyse the performance of Valencian healthcare concessions and their role within the public health system, compares their results with those of some Catalan public and private hospitals. This work is the result of a commission assigned to the Gaspar Casal Foundation and the Centre for Research in Economics and Health at the Pompeu Fabra University in Barcelona. I am hugely satisfied with the outcome and, in this regard, I would like to include in the blog the seven personal reflections that I have shared with the attendees.
THE FIRST is that everybody’s aim must be to preserve the Spanish National Health System, and this requires both direct management and indirect management of the system to be continually assessed and the findings disclosed to society as a whole. And this can never be the desire or will of the concessionaire in indirect management models, but rather an obligation of the financier, of the government, because it seems logical for governments’ decisions to be founded on data and not on opinions.
In recent years, the Alzira Model has witnessed the growth of its international prestige and has seen how, increasingly, it has been the subject matter of study by different public and private entities interested in evaluating its results. In addition to this book that we are unveiling today, and of which I am extremely proud because it responds to our goal of having the utmost transparency with society, I should like to highlight two recent studies, also very important. The study conducted by Berkeley University with Carlos III University of Madrid, of which there are already emphatic conclusions, and the report from the Court of Auditors of the Valencian Government, commissioned by the government itself, which draws five conclusions that I consider essential for everyone to know. And although it now seems that there is interest in not disseminating this study, the full report is available on the Ribera Salud website and on the website of the Court of Auditors itself, where it is available to the public at large.
The five main conclusions of this report, I repeat, made by a public official of the Valencian Government, are:
- The concessional model costs 25% less for the Public Administration.
- It has shorter waiting lists than direct management centres.
- The patient satisfaction index is higher.
- It has better quality-of-care results.
- And it contributes more investment per citizen than at direct management centres.
When these conclusions were read at Harvard University -where the Alzira Model is being studied as a ‘success story’- they called to congratulate me because “with such convincing data from a public report, it is impossible for a government to dismantle the concessional model”, I was told.
MY SECOND REFLECTION is that the challenges are global, not local. All our neighbouring countries are embroiled in processes of reflection on the sustainability of the public system and are using a range of formulas to give efficient responses to social needs. Everyone agrees that there are no magic or unique formulas. It seems that our country is an exception, yet I am sure that as more studies such as the one we are presenting today are conducted, in a mature society, citizens will demand that leaders base their decisions on facts, not on opinions.
THE THIRD REFLECTION is that public debate is positive and necessary. The Alzira Model was launched with a public debate that has always accompanied us. But I would like to say that this debate should not be carried out from confrontational approaches to management models, but rather from the search for approaches that contribute expertise, technology and generate value for citizens. This is what must be demanded of those managing the health system.
IN FOURTH PLACE, I believe that it is essential to have the transparency of all agents: governments, regulators, private companies, etc. For this reason, we regret that it was not possible to use data from the Valencian Community to compile this book, although such data was requested twice from the Ministry of Health and once from the Ministry of Transparency, without obtaining a response to these collaboration requirements in a research study supported by a public university. I am sure that when those in charge of the Administration see the quality of this study, it will serve as a reflection so that in the future they are the ones who promote these types of projects and that they will see that their attitude does not respond to what is expected of leaders in the 21st century.
THE FIFTH REFLECTION is that the core asset of a health system are its professionals. In this regard, we were pioneers in introducing incentive models that would help to involve professionals in management of the model. We have always argued that one of the problems of the traditional public system is the failure to introduce incentive models that reward those that provide the most value. If we advocate this for the professionals, we also believe that the models of private-public partnership should be evaluated and rewards given to those who contribute the highest value and, in any case, terminate the contracts of those that do not contribute value. Because if the consequence of excellent management or poor management is always the same, which is to terminate the contract, how can you maintain that this model provides value over the long term? How must the professionals who are working every day to give the best service to citizens feel?
IN SIXTH PLACE, I believe it is irresponsible to question models using criteria unrelated to the empirical analysis of results. I am concerned that in a community that has the longest waiting lists in its history, nobody has asked how, in the concessional system, we manage to save citizens more than two months’ waiting to undergo surgery vis-à-vis direct management centres, with the detrimental effect that entails from the point of view of citizens’ welfare and of the cost of the system. And it concerns me as a health manager and, above all, as a citizen.
THE SEVENTH REFLECTION is that every human endeavour can be improved. For this reason, the responsibility of everyone is to help to improve and adapt the reality at any given time: governance, mechanisms of control and evaluation of the system and in which I include, of course, direct management and indirect management. We cannot go back to the health model of 30 years ago, which was already questioned 25 years ago in the April Report championed by Julián García Vargas, who I am delighted to see here today and whom I thank for his contribution in the reform and enhancement of our National Health System and his support to the Alzira Model since it was launched in 1999.
IN SUMMARY, the main conclusion is that the solution cannot be something that stopped working 30 years ago.
Many thanks and congratulations to the authors of this magnificent study.
