Sometimes the Community of Madrid maintains a strange silence on the decisions it takes on health matters. For example, starting in 2019, several public hospitals operated by the Quirónsalud company began scheduling patients for MRIs on a new morning shift. Its machines work tirelessly, like those of a factory that never stops producing. After midnight on Saturday at the hospital in Villalba, in the mountains, patients entered the waiting room after passing through a deserted corridor and reception where only an electric hum could be heard. “It felt like I was the protagonist of a horror movie,” said Karen Angove, 51, as she waited for her turn. “I thought there was a morgue in the basement.”
For these patients, nocturnal MRIs are an unusual experience; For Chirón they are a big deal. In exchange for the extra money paid by the regional executive, the company absorbs Madridians desperate due to the growing delays in public hospitals at 100%. The decision is part of a broader strategy that includes visits and surgeries and has increased the number of outpatients treated by the four Quirón hospitals in the public network. The B side of this phenomenon is the delays of a year or more experienced by the local population, for which Chiron receives no additional revenue.
This dysfunction is evident in Villalba Hospital, a relatively small and distant center in the Madrid mountains, which receives more than 30,000 people from Madrid every year from the rest of the region. The goal is to do 26 MRIs between midnight and eight in the morning. The patients, summoned every twenty minutes, do not encounter a single employee until they reach the imaging room, where a technician in a lab coat waits for them next to the tube-shaped machine.
Karen Angove is an out-of-area patient who drove 45 minutes along mountain roads from the city of Venturada to get to her 12:50 a.m. appointment. She works taking care of her grandparents and her back is dirty, so she needs to be looked at. He has been coming to this hospital for three years because the care, he says, is better than in its corresponding hospital, in San Sebastián de los Reyes. “I love the speed,” she says as she sits alone waiting. For each MRI performed on an outpatient, the Community pays Quirón 130 euros; 199 if it is with contrast.
Angove’s satisfaction contrasts with the complaints of several neighbors of the hospital who spoke to EL PAÍS about long waits for some visits and abrupt cancellations by the center. They started noticing delays after the pandemic. These delays coincided with the sustained increase in outpatients for services of any type, which went from 7,508 in the first year of full operation of the hospital, in 2015, to 33,486 in 2023.
Carmen Cabrera, a 65-year-old resident of the area, was delayed several times. On June 10, after being examined by a nurse, she made an appointment with a dermatologist to see some moles that worried her because three carcinomas had already been removed. They gave it to him on September 1, 2026, that is, almost a year and three months later. The delay is so long as to make the data appearing on the regional website of 6.66 days of average waiting to see a dermatologist in Villalba implausible.
He sent a complaint and the appointment was brought forward, in this case to September 9 this year. She has had similar experiences with digestive visits (initial eight-month wait), ophthalmology (one year and one month), and gynecology (four months).
Cabrera is a retired teacher who knows how to defend herself in this system, but she says that other neighbors with fewer resources remain silent and endure. Nor are they aware of the perverse incentive the system has created to attract outpatients, apparently to the detriment of the local population. “This is a bar on Quirón beach,” he protests.
The system was created during the time of Madrid president Esperanza Aguirre, who introduced free choice, meaning that every Madrid resident can be treated in the hospital they want. Therefore, if a patient receives a very late appointment at their hospital or health center, they can change it online or by telephone, and more convenient opportunities often open up in privately run public hospitals.
The idea of free choice was to encourage competition between hospitals to increase the quality of service, but the problem, critics say, is that only a handful of hospitals have the economic incentive to attract patients from outside, and these are Quirón’s own four (the Fundación Jiménez Díaz, Valdemoro, Villalba and Rey Juan Carlos de Móstoles) and another from the Ribera Salud group (Torrejón). The competition is asymmetric because 100% of public hospitals bear costs for each patient outside the territory and the others charge for each one who enters.
It is no coincidence that the champions of outpatient visits are precisely five privately managed public hospitals: in 2023, Jiménez Díaz received 84,082 outpatients, King Juan Carlos 64,820, Villalba 33,486, Torrejón 24,377 and Valdemoro 20,173.
Last year’s data is not known because Isabel Díaz Ayuso’s government omitted them for the first time in the Sermas annual report, where they have appeared for more than a decade. The left-wing opposition saw this repression as evidence of complicity with Quirón, who raised more than 5 billion euros in Ayuso’s six years.
Quirón is obliged in Villalba to provide services to 127,000 people from eight municipalities (Collado Villalba, Alpedrete, Moralzarzal, Becerril de la Sierra, Cercedilla, Navacerrada, Collado Mediano and Los Molinos). But here the avalanche of outpatients is visible to the naked eye. The parking lot has become too small and hundreds of cars park in open fields or on sidewalks.
To serve the local population in the four hospitals of Quirón, the Community pays the company a fixed sum every year which provides a budget of 715 million euros for 2025. Then, in a process that lasts years, the “inter-centre billing” is calculated, that is, a bonus is paid for the care of incoming patients and subtracts outgoing ones. This applies to everyone except the Foundation, which does not lose money on patients who flee.
Discriminated?
Patients in the Villalba area say there are services that work quickly and others that are stagnant. For Mónica Camarzana, a 47-year-old resident of Alpedrete, the hospital canceled appointments several times without immediately giving her an alternative. It happened in ophthalmology and gynecology. Julia Ramos, 74, also had the same problem in traumatology. And a patient from Collado Villalba, Teresa Tamarit, 43 years old, received a dermatology visit in February this year for December 2026, that is, almost two years later. Ironically, the regional site reports that the delay for dermatology in February averaged just 2.09 days. According to the Ministry of Health, an average delay is not the same as a specific delay in a specialty.
It is unclear whether the problem is that the waiting list data published on the public website is unrealistic or whether the hospital is discriminating against the local population. The Community ensures that no one is discriminated against and underlines that Villalba is one of the hospitals with the lowest number of patients and, according to internal satisfaction surveys, the one with the most loyal reference population.
However, the Workers’ Commissions suspect that a double standard exists. Samuel Mosquera, head of Madrid’s private healthcare union, says higher rates are the reason for this supposed distinction. “Our operators confirm to us that preferential appointments are given to outpatients, but we cannot prove this, at least to process a complaint.”
Mosquera explains that the evidence must be conclusive and recalls that in May the fraud complaint was filed by an employee of the Jiménez Díaz Foundation who reported that the hospital registered emergency patients as if they were in the ward, which implied a price 30 times higher.
CCOO reports that Quirón’s business with its concession hospitals does not translate into employment improvements for its staff. A process of assemblies to mobilize workers began at the beginning of the month. Technicians carrying out night scans (in Villalba, Valdemoro and Rey Juan Carlos) have complained that the company does not allow them to take breaks and that security has not been strengthened.
Nocturnal resonances have been talked about for years in other places in Spain. Cases have been reported in state-run public hospitals in Malaga, Guadalajara or Catalonia. Unlike Madrid, in these cases the objective was to reduce the waiting list affecting the local population and there was no profit motive. The Ministry did not specify to EL PAÍS whether the night tests are carried out in any 100% public hospitals in Madrid.
The patients who participate in this MRI experiment for night owls regret the sacrifice, but are resigned. Paz de Castro, a 67-year-old resident of Alpedrete, says that when she was summoned in writing for “4 in the morning” she showed up at four in the afternoon because she didn’t even remotely imagine being summoned at dawn. After missing his shift, he called and was offered two times: 2am or 4.30am. He took the second one. “It’s a thankless job, but I’d rather wait a year,” he says.
Another patient waiting her turn early Saturday morning isn’t so happy. María E., a Moralzarzal resident, said she thought it was “a shame” that the hospital only gave her night options. He’s here today because he had to pick a weekend night so he wouldn’t miss work the next day.
This patient had an MRI on her knee, but her orthopedic surgeon won’t see her until May. They had given him that other appointment in June, meaning he will have to wait almost a year from when he requested it. How long does trauma counseling last according to the official website? 17.2 days. Nobody here believes it.
Do you have something to say? Write to the author at fpeinado@elpais.es
