Privatisation in Spain provokes protests among doctors

BMJ 2012; 345 doi: (Published 13 November 2012) Cite this as: BMJ 2012;345:e7655
  1. Aser García Rada
  1. 1Madrid

A Spanish professional society of doctors has announced an indefinite strike in Madrid and healthcare workers have started sit-in protests at 12 hospitals over the increasing privatisation of the Madrid region’s health service and the levying of a €1 (£0.80; $1.30) charge on prescriptions.

Six hospitals in Madrid will shortly be taken over by private companies in the largest single step towards privatisation in Spain in the past year. The move was announced by Ignacio Gonzalez, the new president of the autonomous region of Madrid, who is a leading member of the conservative People’s Party.

All six hospitals (Infanta Leonor, Infanta Sofía, Infanta Cristina, del Henares, del Sureste, and del Tajo) had already privatised their auxiliary services, such as laundry, catering, and maintenance, but privatisation will now be extended to their staff, including doctors and nurses. More than 5500 workers will be affected, regional unions have said.

The six are among 10 new hospitals opened in Madrid since 2003 under different types of public-private partnership, in line with a general boom in the construction of healthcare facilities throughout the country.1

Pepe Martínez Olmos of the opposition Socialist Workers’ Party, a former general secretary of the health ministry, warned the public before last year’s general election that if the People’s Party won then privatisation of public hospitals would proceed further.2

Although the People’s Party said before the election that it had no plans for privatising existing public hospitals, once it came to power it announced the privatisation of four new public hospitals in Castile-La Mancha, a region governed by the party.

Apart from Catalonia, which has always had a strong private sector, privatisation is expanding in all the regions governed by the People’s Party.

The pattern being followed was set in 1999 in the autonomous Valencia region, where the new Hospital of la Ribera in Alzira was opened, with the entire management run by a private company, Ribera Salud. That arrangement is now commonly referred to as the “Alzira model.”

Four years later Ribera Salud also took over the management of the hospital’s associated primary healthcare centres in 2003, and in 2009 it made a profit of €2.1m.

Four other Valencian hospitals and their healthcare centres followed this model, and the regional government has announced the privatisation of the management of auxiliary services in all healthcare centres by 2013.

In addition, one hospital is to be privatised in the Rioja region; and two hospitals in Extremadura and one in Galicia will shortly open under a private finance initiative model.

Other controversial measures have been announced in Madrid, including the privatisation of 27 regional primary health care centres and of auxiliary services in all regional public hospitals.

The €1 prescription charge, which will start in the Madrid region in January 2013, was first introduced in June in Catalonia, leading to controversy even among members of the People’s Party. Mariano Rajoy, Spain’s prime minister and chairman of the People’s Party, opposes the measure.

These decisions have provoked strong opposition from the trade unions, medical colleges, scientific societies, and association of deans, students, and patients, which have demanded their withdrawal. The indefinite doctors’ strike announced by the doctors’ association AFEM (Asociación de Facultativos Especialistas de Madrid) is set to begin in the last week of November.


Cite this as: BMJ 2012;345:e7655


  • Read Aser Garcia Rada’s BMJ Group blog “The end of a public healthcare system in Spain” at