In March 2023, the Madrid government received a compensation claim: the private company Ribera Salud, which manages the public hospital in Torrejón, requested more than 53 million euros. The reason given was expenses that were not accounted for in the original contract with the region. It took over two years to get a response, but in July 2025, authorities decided: the hospital will receive nearly 33 million euros from the budget.
This move was explained as necessary to cover the costs of new medicines, technologies, and services that hadn’t been foreseen when the agreement was signed. As a result, official documents show the operator’s financial position became so dire that it was recognized as virtually insolvent.
Financial crisis
Over the course of two years, Ribera Salud repeatedly appealed to regional authorities to revise the contract terms. The first request came in December 2022, followed by others in March, January, and April in the following years. With each new appeal, the situation grew more urgent and the demands became more insistent.
According to the documents, the company insisted on a regular five-year review of the balance to secure compensation for the introduction of new medical services and technologies. Ultimately, Madrid authorities acknowledged that the hospital faced an “emergency,” and its financial position was described as “practically insolvent” due to mounting losses and negative equity.
Causes of losses
The main causes of the crisis are cited as inflation, demographic changes, and the sharp increase in the cost of modern medications. Despite a growing population, per-patient funding has hardly risen. At the same time, spending on new drugs and equipment has increased year by year.
Some concrete figures illustrate the issue: spending on abortions at other clinics totaled nearly one million euros over seven years; spending on new drugs jumped from zero to seven million euros per year, and on sensors for diabetes patients—from zero to 633,000 euros. More than five million euros were spent on nuclear medicine over the same period.
Management Model
The hospital in Torrejón follows a ‘risk and reward’ model: a company builds the facility at its own expense and then manages it for 30 years, receiving annual payments from the state. After the contract ends, the facility becomes the property of the region. However, profit is not guaranteed, and losses fall on the managing company.
In recent years, Ribera Salud has faced serious financial difficulties, including debts that reached 124 million euros in 2022. This is tied to a model introduced during the government of Esperanza Aguirre, when private companies built and operated hospitals under long-term concession agreements.
Arguments of the Parties
Madrid authorities, in justifying their decision, emphasized that the hospital continued to provide all necessary medical services despite financial difficulties. The management company presented detailed calculations confirming increased expenses for innovative treatments, new technologies, and outsourced services at external clinics.
As a result, the regional government acknowledged that due to unforeseen circumstances and additional costs, fulfilling the contract had become too burdensome for the company. Therefore, the decision was made to allocate nearly 33 million euros to restore the financial balance.
In case you didn’t know, Ribera Salud is a major Spanish company specializing in managing medical institutions through a public-private partnership model. It operates in several regions of the country and is known for implementing innovative approaches in healthcare. In recent years, the company has faced criticism due to financial challenges and disputes over the effectiveness of its management model.
