The Alzira model takes its name from the town in Valencia where the first Spanish public hospital managed by administrative concession was built in 1999: the La Ribera Hospital, based on four fundamental pillars: public ownership, public control, public financing and private management

The Spanish Constitution explicitly recognises the Right to health care of all the citizens and the obligation of the public authorities to guarantee this right. In this sense, the General Health Act, approved in 1986, includes the creation of the National Health Service to guarantee the provision of public health care, comprehensively and free of charge for the entire population, with public financing.

Some years later, the verification of limited budgetary resources and a higher public demand, forced health service managers to look for new, more efficient, management services, providing the best quality at the lowest possible cost, so maximising the possibilities of the public budgets.

The April 1991 Report echoed the new challenges the NHS was facing and set out alternatives that could help in its maintenance and viability. This report introduced concepts such as the separation between financing, purchasing and provision of the health services and the need to introduce changes to allow for making administrative regulations more flexible for a better management of the human and material resources.

The culmination of the reflection process on the future of Spanish health system came with Law 15/1997 of 25 April, approved by the two biggest political parties in Spain, opening up the possibility for the health care services to be offered by legal institutions other than the State itself. The Regional Government of Valencia developed this Law to start up the La Ribera Hospital in the town of Alzira, managed by the administrative concession model, the first time the comprehensive management of the public health service was applied in Europe.

Nevertheless, the ‘Alzira model’ can be considered as the heir of this reflection process and also of the policies established and changes introduced by the British Labour Government and Swedish Social Democratic Government, although the Regional Government of Valencia’s project goes one step further, on including for the first time ever the capitated payment system in the public health system.

Ribera Salud