Podcast Summary: Hoy por Hoy – "Los pacientes somos muy rentables": Un análisis sobre los centros públicos de gestión privada

Host: Cadena SER – Àngels Barceló
Guest: José Miguel Repullo, Profesor Emérito de Planificación y Economía de la Salud, Escuela Nacional de Sanidad
Date: December 8, 2025

Overview

In this episode, Àngels Barceló leads an illuminating interview with José Miguel Repullo, a leading Spanish expert in health planning and economics, to dissect the model of public healthcare centers managed privately—a system currently under intense scrutiny. Stemming from a recent scandal involving audios leaked from the CEO of Ribera Salud, the discussion explores structural flaws, ethical problems, regulatory gaps, and the broader consequences for public health. The conversation provides a critical, insider perspective on the risks of mixing private management with public healthcare responsibilities.

Key Discussion Points & Insights

1. Context: Recent Scandal & the Nature of the Issue

[00:10–00:32]

• Barceló references audios from the CEO of Ribera Salud and remarks by Madrid's president, who downplayed the controversy as mere "rencilla entre directivos" (a spat between executives).
• Repullo quickly reframes the discussion, emphasizing that:
  • The type of contract involved invites manipulation of both demand and supply in healthcare.
  • This system "externalizes assurance" and "cedes a responsibility that public authorities should never surrender" — raising serious questions about public stewardship.

2. Perverse Incentives in Private Management

[00:57–01:55]

• Barceló cites an El País interview with Isabel González (former manager of Hospital de la Ribera) exposing problematic incentives:
  • Doctors received bonuses for attracting patients from outside departments and for giving early discharges (even when medically ill-advised).
• Repullo expands:
  • "La estructura del contrato... crea un modelo con muchas posibilidades de corromper virtud profesional y la capacidad de responder con una ética."
    (“The structure of the contract... creates a model with many chances of corrupting professional virtue and ethical capability.”) – [02:30]
  • The best way to avoid such problems is not to create “temptations”—but the current model is rife with them.
  • He strongly critiques the "concesional management model" (public-private collaboration for hospital control), calling it “desaconsejable” (inadvisable) for Spain's health system.

3. Regulatory Supervision & Systemic Weaknesses

[02:54–04:01]

• Barceló presses on who supervises these practices.
• Repullo replies:
  • In theory, there is oversight, but in practice, contract complexity and “proximidad” (“closeness”) between regulators and regulated parties breed problems.
  • Describes a landscape with “amistades peligrosas” (“dangerous friendships”), limited competition, revolving doors, and weak governance.
  • Suggests that this system might work in “idyllic countries” with high public and private ethics—but “no diría que esto es muy aplicable a nuestro entorno” (“I wouldn’t say it’s very applicable here”).

4. Legal Levers & the Way Forward

[04:01–05:34]

• Barceló asks about proposed legislative changes (referencing a debate on Law 15/97).
• Repullo’s take:
  • The current law has enabled these models, but Spain’s autonomous regions have significant self-governing power, often confirmed by the Constitutional Court.
  • Advocates not for mere legal change, but for robust systems of “good governance, accountability, transparency”, and prioritizing “entidades sin ánimo de lucro” (non-profit entities).
  • Suggests technical criteria are needed to make it much harder to allow models that undermine the public interest.

5. Public Shock & the "Admitted" Nature of Profit from Patients

[05:34–06:52]

• Barceló asks Repullo’s reaction to the Ribera Salud audios.
• Repullo notes the impact of hearing “obscena” (obscene) evidence of what was previously suspected.
  • “Es sorprendente... no hay decoro a la hora de jactarse de políticas que yo creo que son enormemente peligrosas.”
    (“It’s surprising... there’s no decorum when boasting about policies I think are extremely dangerous.”) – [06:00]
  • Observes a new era (“el trompoceno”) where perverse conduct is displayed openly, calling for consequences.
• On the question, "Are patients a good business?" Repullo answers bluntly:
  • “Sí, sí, sí, lo somos.” (“Yes, absolutely, we are.”) – [06:47]
  • Points to the wider pharmaceutical monopolies, the commercialization of ‘wellness’, and an anthropological, not just political, problem of health system exploitation.

Notable Quotes & Memorable Moments

• On the Danger of the Model:
  "La mejor manera de que no exista este riesgo es que no haya tentaciones y aquí hay muchas, muchas y muy potentes."
  (“The best way to avoid this risk is to remove temptation—and here, there are many, many, and very powerful temptations.”)
  — José Miguel Repullo [02:38]
• On Oversight Failures:
  “Donde hay gente que le ha llamado esto las amistades peligrosas, hay poca concurrencia de empresas, hay una relación muy próxima, hay puertas giratorias. No es un gran modelo...”
  (“Where there’s what some call ‘dangerous friendships’, few competing companies, close relationships, revolving doors. Not a great model...”)
  — José Miguel Repullo [03:40]
• On the "Obscenity" of the Scandal:
  "Sorprende... tener una evidencia, como dirían, obscena del comportamiento fuera de todo tipo de lógica."
  (“It’s surprising... to have, as they’d say, obscene evidence of behavior outside all reason.”)
  — José Miguel Repullo [05:51]
• On Patients as a Business:
  "Sí, sí, sí, lo somos."
  (“Yes, yes, yes, we are [a profitable business].”)
  — José Miguel Repullo [06:47]

Important Timestamps

• 00:10: Introduction of controversy and the broader problem of public-private healthcare contracts
• 01:00: Detailed breakdown of perverse incentives in privately managed hospitals
• 02:04: Professional ethics and vulnerabilities in the current system
• 03:00: Lack of adequate surveillance and the dangers of regulatory-corporate proximity
• 04:13: Legal changes and the limits of autonomy in the healthcare model
• 05:39: On the public’s shock at the Ribera Salud audios
• 06:47: Blunt confirmation that patients are “very profitable” to the system

Conclusion

Tone:
The conversation is candid, analytical, and critical, with Repullo providing thoughtful, sometimes blunt insights into the systemic problems of privatizing public healthcare management. Barceló steers the interview with a focus on real-world consequences, ethical lapses, and possible solutions, maintaining journalistic rigor.

For Listeners:
If you want to understand why the Spanish health system is making headlines, which structural issues are at play, and why experts like José Miguel Repullo call for stronger ethical and regulatory boundaries, this episode provides both context and actionable insights.