The received wisdom is that private healthcare and care is different in each country, depending upon the regulations. That may be so, but the way they make money, when working for a public payor, is similar across Europe.

It can be described as stopping employees from skiving off. This underlies the Alzira model in Spain, where private operators look after the primary and secondary needs of a population for a per capita fee which is around 30% less than the public sector. As one Alzira manager put it: “Spanish doctors are used to working slowly in the mornings and then taking the afternoon off and working hard, privately. Alzira works by paying doctors bigger bonuses for working all their contracted hours.”

The same applies in Germany, according to a manager at one of the big three hospital chains. “In badly managed public hospitals the surgeons work from 8 to 12 and then disappear. When we take over a hospital, we ask them to work afternoons. Invariably, they tell us that all their patients are emergencies who can not be scheduled for the afternoon shift. We then get the anaesthetists to monitor their behaviour. We quickly we find non-emergency cases.”

He says that if the managers of a municipally-run public hospital try to pull a similar stunt, the surgeon complains to the mayor, who tells the managers to ease off, or face hostile press coverage about lives being at risk.

The same applies in care homes in Germany. The manager, who used to run a 400 bed unit, says that his supervisory board was made up of 10 politicians and five employees from the works council. “The politicians didn’t read my memos and made no positive contribution. The workers’ reps could be won over – they had an interest in keeping the care home going.”
Allowing politicians to micro manage health and care delivery makes change all but impossible. Everyone is trying to make a profit from healthcare. The only difference is that for a doctor that takes the form of three hours off, whilst for a private operator it equates to a certain level of EBITDA.