Value-based outsourcing is associated with improved clinical, efficiency and patient satisfaction metrics: a decade of public data from a European health care system

Over the past decade, North American and European health care systems have opted for policies based on the tenets of value-based health care (VBHC), aiming to improve health outcomes, reduce care-related expenditure, and provide care sustainably. As well as promoting healthy competition between health care providers, VBHC aims to drive collaboration between players, including those in primary and secondary care and public and private providers. Long-standing trends toward increased outsourcing of publicly owned facilities to private organizations have generated heated debate, especially in Europe, regarding potential conflicts between ensuring quality of care and implementing cost-reduction strategies to increase economic benefits. In this context, outsourcing to private networks with a strong commitment to VBHC may be a successful strategy for improving health outcomes and lowering costs while overcoming potential drawbacks voiced by opponents of outsourcing. The Regional Health Care System of Madrid (RHSM), Spain, stands out as a best practice model in European health care, providing universal coverage to around 7 million inhabitants (14% of the nation’s population) through a robust network of primary care centers and hospitals, of which several are outsourced to private providers. The RHSM is characterized by a centralized database and transparent reporting system to monitor quality metrics across hospitals and other health care structures, as well as a free-choice mandate, which empowers inhabitants to seek care at the center of their choice at zero out-of-pocket cost, thus overcoming social inequalities in access to care. The authors analyzed publicly available data from 25 public hospitals in the RHSM from 2015 to 2023, comparing quality of care, efficiency, and patient experience metrics from four hospitals outsourced to the value-based Quirónsalud Health Care Network and 22 publicly managed hospitals. Their results provide longitudinal evidence that value-based outsourcing is associated with lower standardized inpatient mortality rates, reduced medical and surgical inpatient complications (3.22% vs. 3.75%; P<0.001), lower average lengths of hospital stays (4.93 days vs. 5.83 days; P<0.001; 95% confidence interval [CI], −0.89 to 0.90), and higher patient experience survey scores (93.1 vs. 88.6; P<0.001; 95% CI, 3.75 to 4.93) than the results from other nonoutsourced hospitals. Significantly more patients were transferred to outsourced hospitals than to nonoutsourced hospitals, with more than half of the patients coming from areas with worse socioeconomic status. The authors’ findings suggest that, in the context of a regional health care system providing excellent universal coverage to residents at zero out-of-pocket cost, along with free choice of health provider, value-based outsourcing is associated with increased quality of care, efficiency, and patient satisfaction, as well as helping to reduce inequalities in access to care in areas with lower socioeconomic status. Outsourcing to value-based networks may catalyze system transformation toward VBHC, while fostering healthy, patient-centered competition between private providers.