Las colaboraciones o concesiones público-privadas (CPPs), aplicadas principalmente en la sanidad o la educación, se han disparado en los últimos años en España. Bajo el mantra de que lo privado es “más eficaz”, apuntan en el último informe de la Auditoría Ciudadana de la Deuda en Sanidad (Audita Sanidad), “hay que invitar y facilitar al sector privado a su participación en los sectores que tradicionalmente han sido de dominio público para que vayan funcionando mejor”.

En dicho estudio, que lleva por título Las Colaboraciones Público Privadas en el proceso de privatización de la sanidad pública, recuerdan que este sistema nació en 1992 en el Reino Unido “como una treta contable para esquivar las restricciones del Gobierno sobre el endeudamiento público, punto que sigue siendo la principal atracción para los gobiernos y las instituciones internacionales”.

24 hospitales en España son fruto de la colaboración público-privada

Desde Audita Sanidad diferencian los dos casos más habituales de esta colaboración que se dan en la sanidad. Por un lado, el conocido como modelo PFI (del inglés Private Finance Initiative). Consiste en que “empresas privadas, la mayoría empresas constructoras, ejecutan y financian la construcción de los hospitales según un contrato de concesión de obra pública, a cambio de recibir un canon anual por el arrendamiento del edificio y, lo que fue novedoso, por la provisión de los servicios no sanitarios durante 30 años”, detallan.

La otra variante es el PPP (Public Private Partnership), que, según el informe, se diferencia del anterior en que “la gestión de los servicios sanitarios y los mal llamados no sanitarios corresponde a una empresa privada”.

Con estas concesiones a largo plazo, “la financiación se realiza mediante una remuneración per cápita de la Administración en función del área sanitaria cubierta y un pago adicional por los pacientes que, sin estar en su área de cobertura, quieren tratarse en sus centros a través del sistema de libre elección de hospital”, señalan.

Actualmente, con la información recabada por Audita Sanidad hay en España 15 hospitales adjudicados que se han llevado a cabo con el modelo PFI y ocho con el PPP.

Destacan los 11 que hay en la Comunidad de Madrid y los cuatro de la Comunidad Valenciana, que, en opinión de los autores del estudio, “han sido la vanguardia y el laboratorio en la aplicación de las políticas neoliberales”.

“La colaboración público-privada es el método más caro de financiación”

Tomando como fuentes diferentes estudios elaborados, entre otros, por el Observatorio de la Deuda en la Globalización, el Tribunal de Cuentas Europeo o Eurodad, en Audita Sanidad señalan que las CPPs son, “en la mayoría de los casos, el método más caro de financiación”, algo que se debe “al tipo de interés más alto para las operaciones de financiación privada en comparación con los préstamos al Gobierno, al hecho de que las empresas del sector privado esperan obtener un beneficio de su inversión, que se añade al coste global de la inversión; o al aumento del coste final de un proyecto a causa de los costes de renegociación”.

Aseguran que la concesión al sector privado de servicios públicos lleva implícitos “recortes financieros, fragmentación de actividades, contratas y subcontratas, reducción de personal y precarización, degradación de las infraestructuras de los servicios públicos, y, sobre todo, la introducción como ley suprema de la rentabilidad económica, degradando el carácter de servicio público y promoviendo la inviabilidad del estado social”. Por todo lo anterior, agregan, “desmontar los sistemas sanitarios públicos es un medio para restringir derechos, trasladar el gasto de algunas prestaciones sanitarias a la población y apropiarse las multinacionales, entre otros, de la asistencia sanitaria, de los seguros médicos y de los fondos públicos destinados a la sanidad”.

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