Focusing on supply, service and construction contracts awarded to private companies in 2020 by the Regional Health Department of the Community of Madrid, this report analyses the influence exerted by the most significant lobbies in the Spanish healthcare sector, in particular within the Community of Madrid.

To this end, the Auditoría Ciudadana de la Deuda en Sanidad - Audita Sanidad, (the Citizen Healthcare Debt Audit work group) has continued with work which began in October 2014 with the publication of the SANITAS BUPA Report and continued with a series of reports on the Regional Health Department’s public contracts in 2014, 2015, 2016 and 2017, the role of the private sector in its budgets and other topics. The work aims to monitor healthcare policies and the activities of the Public Healthcare Administration and in particular to highlight any insidious attempts to privatise healthcare.

At the same time, we wish to underscore the underfunding which is holding back Madrid’s public healthcare system, caused by spending cuts and fiscal policies implemented by successive Partido Popular (the Spanish conservative party) governments, and openly question the debt owed by the Community of Madrid, not only in terms of its origin but also in terms of the lack of transparency surrounding the contracts awarded and the enormous diversions of funding involved (which must be investigated).

We also want to sound the alarm about the ways in which Public Healthcare’s mission and management is distorted, to surreptitiously favour private healthcare. A democracy in which people elected to public positions are later taken in by interest groups acting with ulterior motives and using “undue pressure” is not worthy of the name.

Furthermore, we condemn the fact that the accumulated debt as of the 31st December 2020, an amount of €34,604 million, comprises 148% of the 2020 Budget1 of the Community of Madrid, preventing resources being used for public spending and generating need and poverty within society. It is clear that the government of the Community of Madrid, heavily influenced by its creditors and by civil servants and other people particularly susceptible to undue pressure, does not serve the interests of the general public, and instead serves the interests of a minority which will continue to get rich at the taxpayer’s expense unless citizens audit the constantly increasing debts, reject illegitimately incurred public costs and in doing so free up economic resources to improve the quality of life of the majority of the population.

In this report we will also highlight the activities of the healthcare lobbies and the consequences of their presence in the sector. We will focus exclusively on contracting data: that is to say, we will limit ourselves to reviewing public contracts and the lobbying activity associated with them.

Therefore, we emphasise that the results of this study do not illustrate the extent of the lobbies’ significance and that fully describing their ambitions (to take ownership of business sectors created by public healthcare, whether by delivering the most desirable pieces of the business into the hands of private management, by subordinating, impeding or discrediting the proper management of public healthcare or by preventing public health services from competing in the most advanced and future-oriented sectors) would require much more than this.

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