Benefits of private hospital management on the quality of health care within a value-based system: a controlled cohort analysis of tertiary Spanish hospitals

A retrospective controlled cohort analysis of eight tertiary hospitals in the Madrid Regional Health Service found that the one hospital managed through a value-based healthcare network had lower standardized hospital mortality, fewer inpatient complications and hospital-acquired infections, shorter reported stays, a smaller surgical backlog and more patient transfers than seven publicly managed comparison hospitals. The analysis used official annual data published by the regional health authority for 2015–2022 and covered more than 10 million care episodes at the value-based hospital. The researchers reported no significant differences in case-mix complexity between the hospitals.

The study hospital was publicly owned and outsourced to a value-based healthcare network, while the control group consisted of seven tertiary hospitals managed by the regional service. Value-based healthcare is described in the study as a care-delivery model intended to maximize patient outcomes while optimizing resource use through systematic outcome measurement, integrated care pathways and aligned organizational incentives. The comparison examined three domains: quality and safety, operational efficiency, and patient experience, using standardized hospital mortality, complication and infection rates, length-of-stay and surgical-backlog indicators, and survey and hospital-choice measures.

The value-based hospital’s relative risk was 0.62 compared with the control group, a difference reported at P < 0.001. It also had fewer inpatient complications, with a relative risk of 0.87, and the difference reached statistical significance at P = 0.032. Its standardized hospital mortality rate was significantly lower than that of the control group.

These observations applied to the hospital evaluated under the value-based model; they do not establish that private management alone produced the differences. Operational indicators also favored the outsourced hospital. Its length of stay and its case-mix-adjusted average inpatient length of stay, abbreviated CMAILS in the study, were significantly lower than the reference value used for analysis.

The mean surgical backlog was 14.8 days at the study hospital, compared with 67.2 days for the control group, with P < 0.001. Patient-choice data showed a similar separation: an average of 57,688 patients per year chose to transfer to the value-based hospital, compared with an average of 9,291 patients per year for the control hospitals, with P < 0.001. The investigators included survey scores and hospital-choice rates within their assessment of patient satisfaction.

The authors interpreted the combined results as evidence that outsourcing a publicly owned hospital to a value-based network can be associated with improved quality and safety indicators, greater efficiency and higher patient satisfaction. The findings come from a retrospective case-control design based on official publicly available annual data, not from a randomized trial. Only one of the eight hospitals was managed under the value-based model, and the available results do not establish that every hospital adopting a similar contract would achieve the same performance.

The study also cannot determine how much of the observed pattern, if any, could be separated from other institutional or managerial influences.

Subject of Research: Value-based management and comparative quality, safety, efficiency and patient-choice outcomes in eight tertiary hospitals in Madrid from 2015 to 2022.

Article Title: Benefits of private hospital management on the quality of health care within a value-based system: a controlled cohort analysis of tertiary Spanish hospitals

Article References: Álvaro de la Parra, J. A., Arcos, J., Pfang, B., Braithwaite, J., Bernabéu, C., Cristóbal, I., & Caramés, C. (2026). Benefits of private hospital management on the quality of health care within a value-based system: a controlled cohort analysis of tertiary Spanish hospitals. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15635-3

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DOI: 10.1186/s12913-026-15635-3

Keywords: value-based healthcare, hospital management, tertiary hospitals, patient safety, standardized hospital mortality, hospital-acquired infections, inpatient complications, surgical backlog, patient choice, Madrid health service, Benefits, private