PPPs in Spain have had to face hoaxes and defend themselves against all kinds of accusations for many years. And unfortunately it still has to do so. The quality of care, the qualifications of the professionals and even the mortality rates in privately managed public hospitals have been questioned in comparison with those under direct management. In the face of these debates, I have always advocated transparency and education.
Historically, the private sector has preferred not to speak out too loudly or put its strategies, models, plans or actions on the table so as not to enter into a public debate in which it has never felt comfortable because it ends up generating controversy, generally for the worse. It makes no sense to pit public and private against each other, when the management tools and decision-making capacity are different. Moreover, there are always people willing to polemicise rather than debate, to send a tweet rather than reason. And in the private sector, we have always been not to talk too much and let the results speak for us.
However, I have always believed that we should be more proactive, have more presence, and explain things better. In fact, as an important personality from Portugal told me last week, the private sector has to be accountable, by law, to its shareholders, through audits signed by independent experts, which are also public. Also, for some years now, companies have had to submit an annual Sustainability Report or Report on non-financial activity, together with the accounts, to the registry.
All of you who follow this blog know that I try to give my opinion on issues that are almost never free of controversy. And not because I want to enter into an ongoing debate, but because I like to reflect, analyse, educate and give my opinion on current news, in general related to our sector, and especially on everything that has to do with the contribution that public-private partnerships make to society, citizens, professionals, and also to public administration.
A few days ago, one of the most important public universities in Spain, the Complutense University of Madrid, presented a report in which it concludes, for example, that «hospitals under public-private partnership models show better results than the average of public hospitals»; that «the rate of avoidable mortality does not increase with a higher percentage of private sector provision»; and that, logically, «the real capacity of the manager, the legal personality, the administrative and institutional environment, the culture of the centre, the conditions of the contract and the adequate supervision by the funder of the quality of the service provided are the factors that most influence the operation and results of public-private collaboration models». I attach the study, published by Sanifax, at the end of my blog, in case you are interested in reading it in full.
In my opinion, this study is important because it reaffirms what the Court of Auditors of the Valencian Community already said about the public-private partnership model in health, analysing the years from 2003 to 2016. At that time, and always based on objective data and reports from the Regional Ministry of Health itself, this advisory body of the Valencian Regional Government ruled that health indicators, including the mortality rate and life expectancy, were better in privately managed public hospitals, compared to those under direct management. Its conclusions, therefore, contradicted what the pro-state or pro-state or direct management political groups, who were in government at the time the report was written, were advocating. You can read the Sindicatura’s report in full here.
I sincerely believe that when we talk about such delicate and sensitive issues as the health of the population, opinions should be measured and based on the most objective data possible. Obviously, opinions can be based on personal criteria, beliefs or ideology. But then, it must be emphasised that this is a personal opinion, not based on objective and verified data. After years of hearing it said that mortality or complications in one type of hospital is higher than in another, without any objective data and ignoring reports such as that of the Valencian Audit Office, I am pleased to read once again a professional study, signed by renowned academics, confirming that this is not the case. Because it is not a matter of rejoicing over something that many of us already knew, and that our patients in particular know. And that is that private management of public health care is one more tool that governments have to offer excellent quality care and contribute to the sustainability of the system.
That is why, with this blog post, I want to help bring the conclusions of this report, but above all the importance of transparency and the pedagogy of the model to as many citizens as possible.
It is also a good time to demand more transparency from governments and regional administrations, regular reports and public exposure of care indicators, waiting lists and satisfaction surveys to society. As well as demonstrating that there is nothing to hide, it is undoubtedly the best way to plan changes and to address with courage and objective data those areas that could be improved. Public spokespersons should also remember that, with their subjective assessments, they are questioning the professionalism of healthcare professionals and their vocation for service.
Regardless of management models, I am in favour of transparency and education. As a citizen who pays my taxes and who uses public health care when I need it, I am fully committed to its future. Together, we must promote a public health system of excellence, which is transformative, innovative and sustainable, in which comparisons can be made, in which benchmarking is normal, and in which we can all choose, based on the indicators that we each see fit. Always with transparency.
See report