In recent years, the Valencian Community (Comunidad Valenciana) has seen a significant shift in its approach to healthcare management. The Alzira model, once considered innovative and even promising, is gradually fading into the past. Its concept was based on handing over entire healthcare departments to private companies, which would receive a fixed payment per resident. The idea was to create a more sustainable system and improve its efficiency.
However, in practice, things turned out to be far more complex. In the early 2000s, almost a million residents in the region were served under this scheme. Soon, the model expanded to several hospitals in Valencia, and later to other regions, including Madrid. But its success outside Valencia was much more limited. Regional authorities actively promoted the system, claiming it would save public funds and improve service quality through competition among private operators.
Problems and Criticism
From the very beginning, the Alzira model faced serious challenges. Just a few years after its launch, the regional government had to step in and rescue the project from failure. In 2003, contract terms were revised: payments to private companies were increased, while oversight of the process was effectively weakened. This triggered a wave of criticism from experts and the public.
Official reports indicated a lack of proper analysis before the project was launched, weak regulation, and unclear accountability mechanisms. The National Competition Commission noted that most tenders were won by the same company — Ribera Salud — casting doubt on the very idea of competition. As a result, instead of the anticipated savings, the system became a source of new expenses and conflicts.
A change of course
The situation changed after the 2015 elections, when a new government came to power. It was decided to gradually return hospital management to the public sector. This process proved difficult and was accompanied by numerous challenges, but the shift away from privatization was firmly set.
In 2023, even members of the Partido Popular, who had previously supported the Alcira model, agreed not to extend private concessions. This sent a clear signal to the entire sector: the era of healthcare privatization in Valencia is coming to an end. Recent events, including statements from Ribera Salud leadership about the need to increase waiting lists for profit, only fueled public dissatisfaction and accelerated the return to public management.
Consequences for the system
The Alzira model was long considered a benchmark, but it is now described as a failed experiment. Critics point out that financial interests of private companies were prioritized over the quality of healthcare. This is supported by recent scandals involving attempts to manipulate performance indicators to increase profits.
As a result, trust in private operators in the healthcare sector has noticeably declined. Regional authorities are now focusing on developing and modernizing public hospitals, and the Alzira experience serves as a warning for other regions of Spain. The future of such models remains uncertain, but the trend toward the return of state control is clear.
Public reaction
Public opinion in Valencia and other regions of Spain is increasingly favoring state-run healthcare. Citizens are demanding transparency, accountability, and equal access to services. Scandals surrounding Ribera Salud and other private operators have only reinforced these sentiments.
Many experts believe that returning to state management will improve healthcare quality and reduce the risk of corruption. However, this process is slow and requires significant effort from both the authorities and the medical community.
In case you didn’t know, Ribera Salud is the largest private company that managed hospitals under the Alzira model in the Valencian Community. Founded in the late 1990s, it became a symbol of healthcare privatization in the region. The company has repeatedly faced criticism for lack of transparency and prioritizing commercial interests. Following a series of scandals and a shift in political direction, its influence within Spain’s healthcare system has significantly diminished.
