[Privatization in healthcare management: an adverse effect of the economic crisis and a symptom of bad governance. SESPAS report 2014].

It is often asserted that public management of healthcare facilities is inefficient. On the basis of that unproven claim, it is argued that privatization schemes are needed. In this article we review the available evidence, in Spain and other countries, on the application of private management mechanisms to publicly funded systems similar to the Spanish national health system. The evidence suggests that private management of healthcare services is not necessarily better than public management, nor vice versa. Ownership-whether public or private-of health care centers does not determine their performance which, on the contrary, depends on other factors, such as the workplace culture or the practice of suitable monitoring by the public payer. Promoting competition among centers (irrespective of the specific legal form of the management arrangements), however, could indeed lead to improvements under some circumstances. Therefore, it is advisable to cease the narrow-minded debate on the superiority of one or other model in order to focus on improving healthcare services management per se. Understanding that good governance affects health policies, the management of health care organizations, and clinical practice is, undoubtedly, an essential requirement but may not necessarily lead to policies that stimulate the solvency of the system.