Seventeen Ministers for Health!

Spain has 17 autonomous health services and 17 Ministers for Health, Mr. Santiago Delgado, Deputy Manager of the Ribera Salud Grupo, a private group which has been contracted by the state to run a number of hospitals in Spain, told the 9th National Health Summit in Dublin.

Spain has 17 autonomous health services and 17 Ministers for Health, Mr. Santiago Delgado, Deputy Manager of the Ribera Salud Grupo, a private group which has been contracted by the state to run a number of hospitals in Spain, told the Conference. Speaking on “Healthcare in Valencia Spain: Improving the Efficiency of Public Health Services: Lessons for Ireland,” he said that this was For the first time in a National Health Service that a capitative model in healthcare management was implemented.

His company, which works as part of a public/private partnership, has been in Spain for 15 years. He said PPPs were financed through a capitation system. They were paid a fixed annual sum per inhabitant of the area they covered. This annual fee increased in successive years in line with public health budget increases.

With the annual fee the company had to cover all the expenses needed to provide the service (i.e. amortizations, investment plans, payroll, etc.) except extra-hospital pharmaceutical prescription, prostheses, oxygen therapy and medical transport services, which were not included in the contract and were directly paid by the administration.

“They do not seem to know or care who is running the service, they just care about the quality of the service.”

The cost of providing services per inhabitant in Valencia in 2009 was €837.94 The annual fee paid to the contractor was €618.74, or 26 per cent less

“Citizens in the area where we hold the contract are free to go to any other public hospital for their care but if they do so, we are invoiced 100 per cent of the average cost of treatment. We are allowed to make a profit of 7.5 per cent. If we make more we have to re-invest it in the services.

“We opened our first hospital in Valencia in 1999.  In 2003, Valencia decided to include primary care in the contact and today, we are running an entire healthcare network.  People are happy with the service. They do not seem to know or care who is running the service, they just care about the quality of the service.”