Democratic Deficit and Ethical-legal Problems in the Privatization Process of Health Services Management in the Autonomous Region of Madrid

Abstract

The context of severe crisis and budgetary constraints in Spain serves as a pretext to establish in the autonomous region of Madrid a dual model of healthcare management, largely contested by health professionals, associations, patients and users of the public health system. This process starts without scientific evidence supporting the alleged technical advantages of the trusted (concession) model, and lacks a basic "health impact assessment", according to standards of transparency and accountability. Among the ethical and legal issues involved in this debate, I discuss some related to conflict of interest and recent evidence that should discourage of adopting similar models in Spain. After analyzing the challenge of the new institutional framework for professional responsibility, under goals of equity and good practices, some concluding elements are proposed aimed to generate a more balanced framework for reforms.