Objective:

To analyze the possible effect of certification models and healthcare organizations’ (HOs) participation incentives in the General Health Council certification process in the 1999-2017 period.

Materials and methods:

Official printed and online documents about HOs’ certification were collected. Information from instances related to the process was requested through transparency mechanisms. Health organizations’ participation in political-administrative periods between 1997-2017 was analyzed.

Results: The annual average participation in the certification process during the 1999-2000 period was 259.5 HOs; during the 2013-2016 period, the average was 72.5. Public units’ participation in this process has been decreasing. In 2017, certified HO were <1%.

Conclusions:

No positive effects of adjustments to the certification model or the incentives applied were identified. Conversely, there is decreasing participation in the different political-administrative periods. The National HO Certification System and its possible effect on clinical quality must be thoroughly evaluated.