Free health choice is consolidated in Madrid

The free health choice in the Community of Madrid It has established itself as one of the most reliable indicators of the real functioning of the public system. The official data of the Madrid Health Service (Sermas) show that more and more citizens exercise this right and do so in a sustained manner, mostly opting for public hospitals with mixed management integrated into the Madrid public network.

According to the latest data published by Sermas, corresponding to 2024, 247,295 Madrid residents they freely chose one of the public hospitals with mixed management instead of the hospital assigned by your area of ​​residence. This figure represents an increase of 9% compared to the previous year, consolidating a growing trend that has been maintained since the implementation of Law 6/2009 on Free Health Choice.

For more than a decade, these centers have repeatedly topped citizens’ preferences. The Jiménez Díaz Foundation is the clearest example: it has led free choice in the Community of Madrid since 2012 and in 2024 alone it treated 97,587 outpatients, 16% more than the previous year. It is followed by the Rey Juan Carlos Hospital (61,718), the Villalba General Hospital (34,432) and the Infanta Elena Hospital (23,750).

Citizens mostly choose those hospitals that offer them a Faster access, responsive care and a satisfactory care experienceregardless of the management model. For health management experts, these data reflect a voluntary and repeated decision by citizens, based on accumulated healthcare experience, and not on administrative incentives. Free choice works, in practice, as a direct evaluation system, in which hospitals are valued for their accessibility, clinical results and perceived quality.

Waiting lists

One of the determining factors that explain this preference is healthcare accessibility, especially in a context in which Waiting lists are one of the main challenges of the Spanish health system. In a National Health System where the average wait for surgery is 118 days and the delay for a first consultation exceeds 96 days, public hospitals with mixed management systematically stand out with the shortest average delays in the entire Sermas network, becoming the preferred option for those who exercise free choice. Their surgical waiting times range between 13 and 25 days, with the Villalba General Hospital as the hospital with the shortest delay in the entire Madrid network, with 13.52 days on average. In outpatient consultations and diagnostic tests, these centers also appear in the lowest sections of the distribution, according to the SERMAS Results Observatory, favoring faster diagnoses, better continuity of care and more responsive care.

Official data show that these centers concentrate the smallest number of patients pending intervention and contribute decisively to improving the overall indicator of the system. This effect is not limited to patients who choose them directly: by absorbing a relevant part of the demand, they relieve pressure on other hospitals, reducing waiting lists for the entire public network.

Far from generating imbalances, free choice thus acts as a tool for adjustment and efficiency of the system, allowing activity to be diverted to centers with greater response capacity and better organization of care.

Activity

The growth in free choice and the reduction of waiting lists also occurs without an increase in public spending. On the contrary: audited economic data from SERMAS show that public hospitals with mixed management have a lower average cost per inhabitant than directly managed hospitals of the same level of complexity, despite assuming a greater care burden and offering a broader portfolio of services.

The differences are especially significant in medium complexity hospitals (Group II). The Rey Juan Carlos Hospital has a per capita cost that is 51.3% lower than the average for its group, while the Villalba General Hospital has a 52.5% lower cost per inhabitant. The Infanta Elena Hospital, in Group I, also registers a cost that is 10.3% lower than that of equivalent hospitals.

These results are produced within a strictly regulated and supervised financing framework, based on capitative rates and audited public prices. Furthermore, the activity derived from free choice is rewarded with penalties compared to the standard price, being between 10% and 20% below, which further reinforces the efficiency of the model.