Madrid’s public healthcare system is currently navigating one of the most delicate periods in its history. What for decades stood as a pillar of the welfare state, a source of collective pride, is now facing a planned and orchestrated deterioration. This crisis is a direct consequence of the political decisions made by the Popular Party government, which consistently prioritizes private business interests over the fundamental right to health for the population.
A System on the Brink: CCOO’s Long-Standing Warnings
For years, CCOO of Madrid has been vociferously denouncing this alarming trajectory. The system, pushed to the brink of collapse, struggles to meet the real needs of the population. This manifests in a severe shortage of staff in hospitals and health centers, interminable waiting lists, bed closures, saturated emergency rooms, and exhausted professionals abandoning the public sector due to increasingly precarious working conditions.
This model is neither accidental nor inevitable. It is the outcome of a deliberate strategy that has consistently favored private management, feeding on public resources. This approach weakens the public system, thereby justifying its replacement by the private sector. The modus operandi is clear: divert money and healthcare attention towards corporate interests, funds that should rightfully be used to strengthen public services. Who bears the brunt of these consequences? The vast majority of society that cannot afford private healthcare.
Billions for Private Agreements: A Lucrative Business
In recent years, the Community of Madrid has funneled billions of euros from the healthcare budget into private companies that manage public-private partnership centers or concessionaires. Between 2019 and 2024 alone, the regional government paid over 2.559 billion euros more than budgeted to Quirón Salud, Ribera Salud, and other private entities. This accumulates to a staggering total of more than 8.651 billion euros in healthcare agreements with private providers.
These centers, such as those managed by the Quirón Group (Rey Juan Carlos, Infanta Elena, Villalba, or the Fundación Jiménez Díaz) and Ribera Salud’s hospital in Torrejón, have witnessed a surge in their billing and the volume of patients referred from other public hospitals. This reinforces a business model that siphons resources and bleeds the traditional public healthcare system dry, leading to understandable despair among users.
Far from being a solution to waiting lists or saturation, this model has generated perverse market incentives. A recent example includes revelations from the CEO of Ribera Salud, who allegedly suggested deliberately increasing waiting times to maximize profits, prioritizing more lucrative procedures while rejecting less profitable ones. This effectively transforms the sick person into an “attractive client” and health into a commodity. As former Madrid Health Minister Juan José Güemes famously declared years ago: Madrid’s healthcare is a business opportunity.
The Silent Privatization: Pushing Towards Private Insurance
The significant social outcry against privatization processes has prompted successive Popular Party governments in the Community of Madrid to shift their strategy. They are now steering Madrid’s public healthcare towards a process of silent privatization, deepening its deterioration to push the population towards private insurance.
This strategy is yielding significant results. According to the latest report from the insurance industry’s employers’ association, almost 45% of Madrid’s population, approximately 3 million people, now possess health insurance. This figure is significantly higher than the national average (25%). This percentage has soared since Díaz Ayuso took office in 2019 (when it was 34.34%), with almost 500,000 more people now covered by the private sector.
The outcome is a deeply unequal, two-tiered healthcare system. While a significant portion of the higher-income population turns to private insurance to reduce waiting times or access better conditions, the rest continue to suffer unacceptable delays, saturated emergency rooms, and a general deterioration of public services, with exhausted, underpaid, and overwhelmed staff.
These figures highlight that some private concessionaires, with minimal social oversight and limited transparency mechanisms, receive the equivalent of entire budgets of several public centers. Defending public healthcare is not merely about demanding more investment; it is about demanding different priorities, transparent management, genuine equity, dignified working conditions, and a model that puts people before corporate profit.
Francisca Gómez Sánchez is the Secretary of Social Policies and Diversity for CCOO Madrid.
