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Value-Based Outsourcing in Spain Is Associated with Improved Clinical, Efficiency, and Patient Satisfaction Metrics
Juan Antonio Álvaro de la Parra1,2, Ion Cristobal3, Jeffrey Braithwaite4
1General Corporate Director, Quirónsalud Health Care Network, Madrid, Spain.
NEJM Catalyst Innovations in Care Delivery
|July 8, 2026
Summary
Value-based outsourcing in Madrid
Area of Science:
- Health Services Research
- Healthcare Management
- Public Health Policy
Background:
- Value-based health care (VBHC) policies aim to improve outcomes and reduce costs.
- Outsourcing public healthcare facilities to private organizations sparks debate on quality versus cost.
- The Regional Health Care System of Madrid (RHSM) offers universal coverage and free provider choice.
Purpose of the Study:
- To compare quality of care, efficiency, and patient experience between outsourced and publicly managed hospitals in Madrid.
- To assess the impact of value-based outsourcing on health care delivery within a universal coverage system.
Main Methods:
- Analysis of publicly available data from 25 hospitals in the RHSM (2015-2023).
- Comparison of metrics between 4 hospitals outsourced to a value-based network and 22 publicly managed hospitals.
- Inclusion of data on patient transfers from lower socioeconomic status areas.
Main Results:
- Value-based outsourcing was linked to lower inpatient mortality and fewer complications.
- Outsourced hospitals showed shorter average hospital stays and higher patient satisfaction scores.
- Outsourced hospitals served a higher proportion of patients from disadvantaged socioeconomic backgrounds.
Conclusions:
- Value-based outsourcing can enhance healthcare quality, efficiency, and patient satisfaction.
- Outsourcing to VBHC networks may reduce health inequalities and drive system transformation.
- The Madrid model demonstrates successful integration of value-based outsourcing within a public system.
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