Health Services and Policy Research Group, Institute for Health Sciences in Aragón, IACS, Aragon, Spain.
Department of Management, School of Engineering and Architecture, University of Zaragoza, Aragon, Spain.
Health Policy. 2019 Apr;123(4):408-411. doi: 10.1016/j.healthpol.2019.01.012. Epub 2019 Feb 2.
In the statutory Spanish National Health System (SNHS), the role of public provision is prominent. Nonetheless, since the inception of the SNHS, Regional Health Authorities have also purchased hospital care from private not-for-profit or for-profit providers, usually complementing public provision. Over the years, the autonomous community of Valencia has championed the use of Public Private Partnerships (PPP) in the form of administrative concessions (AC) awarded to private providers. In the La Ribera Health Department, which includes Alzira, the company Ribera Salud held the concession to provide hospital and primary care to the registered population since 1999 - and this became known as the Alzira model. In April 2018, when the administrative concession was expected to be renewed, Valencia's Health Authority decided to terminate the concession and to revert to direct public provision. While most stakeholders - and in particular the left-wing regional government - were in favour of reverting to public provision, advocates of the Alzira model argued that it was superior in terms of productivity, per capita expenditure and quality. The termination of the Alzira model led to further regulatory changes enacted in the Law for Health 8/2018, which clearly states that public provision is the preferred model of service delivery and new (tighter) requirements are defined for any future PPPs aiming to settle in the autonomous community of Valencia. This paper describes the process and provides background information to understand the underlying reasons of this policy development.
在西班牙法定国家卫生系统（SNHS）中，公共供应的角色尤为突出。然而，自 SNHS 成立以来，地区卫生当局也一直从非营利或营利性私营提供者那里购买医院护理服务，通常是为了补充公共供应。多年来，巴伦西亚自治区一直倡导以授予私营提供者的行政特许权（AC）的形式使用公私合作伙伴关系（PPP）。在包括阿尔齐拉在内的拉里贝拉卫生局，里贝拉医疗保健公司自 1999 年以来一直拥有向注册人口提供医院和初级保健的特许权，这就是所谓的阿尔齐拉模式。2018 年 4 月，当行政特许权预计将续签时，瓦伦西亚卫生局决定终止特许权，恢复直接公共供应。虽然大多数利益攸关方——特别是左翼地区政府——都赞成恢复公共供应，但阿尔齐拉模式的支持者认为，就生产力、人均支出和质量而言，该模式更优越。阿尔齐拉模式的终止导致了 2018 年 8 月健康法 8/2018 中颁布的进一步监管改革，该法明确规定公共供应是服务提供的首选模式，并为任何旨在在瓦伦西亚自治区定居的未来 PPP 定义了新的（更严格）要求。本文描述了这一政策制定的过程，并提供了背景信息，以了解这一政策发展的根本原因。
