{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:06:33Z","timestamp":1783350393749,"version":"3.54.6"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Outsourcing to private healthcare providers is a topic of intense debate and with contradictory results published in the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this study, we aimed to analyze the effects of outsourcing to a private provider that follows a value-based model on official indicators of quality, functioning and accessibility, safety, and patient experience recently published by the Madrid regional health system for the year 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Notably, we found that the study hospital showed lower mortality rates, surgical and medical complications, and hospital-acquired infections than its peers. Moreover, the study hospital had significantly shorter length of stay and surgical backlog, highlighting its high levels of functioning and accessibility. Regarding patient satisfaction with the care received, the study hospital showed a significantly higher satisfaction index than the control group. Accordingly, the indicator of free choice of medical care available in the Community of Madrid showed that it was a net importer of patients from other tertiary hospitals included in this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our findings support the idea that outsourcing to value-based healthcare providers represents a valid alternative that does not compromise the overall quality of healthcare offered to patients. On the contrary, this strategy could not only improve indicators but also reveal potential initiatives that will contribute to improving outcomes in public hospitals, creating a positive synergistic loop.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1652798","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T05:25:36Z","timestamp":1757568336000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact on healthcare and operational outcomes of outsourcing to a private value-based provider: analysis of tertiary hospitals in the Community of Madrid"],"prefix":"10.3389","volume":"13","author":[{"given":"Cristina","family":"Caram\u00e9s","sequence":"first","affiliation":[{"name":"Quir\u00f3nsalud Healthcare Network, Grupo Hospitalario Quir\u00f3nsalud","place":["Madrid, Spain"]},{"name":"Programa de Doctorado en Medicina y Cirug\u00eda, Universidad Aut\u00f3noma de Madrid","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Arcos","sequence":"additional","affiliation":[{"name":"Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadette","family":"Pfang","sequence":"additional","affiliation":[{"name":"Clinical and Organizational Innovations Unit, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ion","family":"Crist\u00f3bal","sequence":"additional","affiliation":[{"name":"Quir\u00f3nsalud Healthcare Network, Grupo Hospitalario Quir\u00f3nsalud","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Antonio","family":"\u00c1lvaro de la Parra","sequence":"additional","affiliation":[{"name":"Quir\u00f3nsalud Healthcare Network, Grupo Hospitalario Quir\u00f3nsalud","place":["Madrid, Spain"]},{"name":"Escuela de Doctorado UAM, Centro de Estudios de Posgrado, Universidad Aut\u00f3noma de Madrid","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e0287207","DOI":"10.1371\/journal.pone.0287207","article-title":"The cost of aging: economic growth perspectives for Europe","volume":"18","author":"Jayawardhana","year":"2023","journal-title":"PLoS One"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e0160264","DOI":"10.1371\/journal.pone.0160264","article-title":"Time trends in prevalence of chronic diseases and multimorbidity not only due to aging: data from general practices and health surveys","volume":"11","author":"Van Oostrom","year":"2016","journal-title":"PLoS One"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e199","DOI":"10.1016\/S2468-2667(24)00003-3","article-title":"The effect of health-care privatisation on the quality of care","volume":"9","author":"Goodair","year":"2024","journal-title":"Lancet Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"5249","DOI":"10.1016\/j.healthpol.2025.105249","article-title":"Could hospitals operating through a value-based healthcare policy overcome potential management drawbacks in European healthcare?","volume":"152","author":"Caram\u00e9s","year":"2025","journal-title":"Health Policy"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1484709","DOI":"10.3389\/fpubh.2024.1484709","article-title":"Value-based care as a solution to resolve the open debate on public healthcare outsourcing in Europe: what do the available data say?","volume":"12","author":"Caram\u00e9s","year":"2024","journal-title":"Front Public Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"4941","DOI":"10.1016\/J.HEALTHPOL.2023.104941","article-title":"\u2018Accident and emergency\u2019? 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