Health and long-term care for the elderly systems in Spain: public-private partnerships and institutional performance

This article analyses the use of public-private partnerships in health policy and in the long-term care sector for the elderly in Spain. By analysing quantitative data from different official sources, the paper starts from the context and the evolution of both sectors and explores the existence of possible correlations between the use of indirect management models by the Autonomous Communities in the implementation of these essential services and their performance expressed in indicators of expenditure, available means and results achieved. The research shows that contextual variables and the resort to private operators have a strong influence on the provision of health services, while in the long-term care sector the size of the nursing homes has been more decisive as an explanatory factor for mortality rates associated with covid-19 than their legal nature, whether public or private.