International health co-operative conference, Spain

1. Report on the International Seminar
on Healthcare and Co-operatives
Sergi Rodríguez
A
number of years ago, a well- emphasized, “The need for creating synergies
known international hotel using this social healthcare model invites us
chain began construction on all to analyze which forms of collaboration
one of Barcelona’s principal are possible with the public system, to the
avenues to hold their first end of ensuring their viability.” Shortly after,
establishment in the city, he read aloud a letter from Pasqual Maragall,
with which they hoped to President of the Catalan Government.
make their entry into the Spanish market. The next speaker was the ACI director for
Owing to problems with administrative permits, Knowledge Management, Gabriela Sozanski,
the project was never completed, and that who pointed to “the enormous potential for
imposing structure on Diagonal ended up co-operation between administrations and
housing Barcelona Hospital. co-operatives initiating activity in this
Dr. Josep O. Gras,
President of the Espriu
While it could seem like a paradox, it socio-economic reality,” while in his turn,
Foundation, welcomed the isn’t. All these years later, as destiny would the president of the International Health
participants to the Seminar. have it, the Hilton Hotel provided the site for Co-operatives Organization (IHCO), José Carlos
an important event in the world of health co- Guisado, reminded everyone of the importance
operatives: the International Seminar on to “not lose sight of our common goal to offer
Healthcare and Co-operatives, sponsored by the best possible service to citizens, who are
an organization none other than the Espriu the ultimate beneficiaries of the healthcare
Foundation, one of whose Board members is system.” Next came the turn of Alfonso
the same entity (SCIAS) that took over the Jiménez, Director General of the Cohesion de
construction of the Barcelona Hospital. SNS of the Ministry of Labor and Social
And it was appropriate to the occasion. Welfare, for whom “health care organizations,
During two entire days, 200 co-operative by virtue of their very nature, (are bound) have
leaders, institutional representatives and an inherent social responsibility that obliges
field experts convened to discuss the global them to supplement and enrich today’s public
evolution of health co-operatives and the healthcare systems.”
current situation of various public healthcare
systems. The gathering attested to the Goal: Guarantee the Level of Service
increasing role co-operation between private The inaugural session of the Seminar was
and public models has assumed with the presided over by the Health Minister for the
finality of guaranteeing quality attention to Catalan Government, Marina Geli, who
citizens. pointed out the historical importance co-
The high level meeting, which marked a operatives have had in the country: “They
milestone in the recent history of health co- found fertile ground in the Catalan civil
operatives, began first thing in the morning society, whose same dynamism had previously
on the 20th with the official opening of the drove the trade union, mutual societies and
Alfonso Jiménez, Director Seminar. Dr. Josep Oriol, president of the charities movements,” she said.
General of the Cohesion de
Espriu Foundation, began the proceedings She continued with an analysis of the
SNS of the Ministry of Labor
and Social Welfare. by welcoming everyone and recognizing the current structure of the healthcare system,
“debt we all owe to Dr. Josep Espriu.” He whose origins should be traced to the 1981
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2. legislative reforms that first established a not. This makes it necessary to “know how to
healthcare system of a public character albeit identify needs and how to address them in
one with different provisions, in which “the order to avoid frustration on the part of both
private healthcare model began to assume a professionals and patients. The public model
complementary role. Let’s not forget that 24% needs the private when it comes to waiting
of all Catalans have private insurance.” This lists and state-of-the-art medical equipment,”
new framework was finalized in 1986 with Agustí said.
the subsequent reform that established a Next, Carmen Román, Director General of
financing model that relied more upon taxes MUFACE (the General Mutual Society of State
than quotas. However, over the years, one of Civil Servants) described their unique model
the model’s characteristic features—universal that combines the public and private.
access – has been ultimately responsible for Essentially, 2.5 million members throughout The opening address was given by
collapsing the system, or depersonalizing it Spain enrolled in MUFACE have their own Social the Catalan Government’s Minister
of Health, Marina Geli
(feeling more like a user of the system rather Security plan that allows them to choose
than an owner), or magnifying it (placing too services offered by either public or private
many expectations). providers. Some 86.5% of them choose the latter
The major challenge would be that of option, through five contracted companies.
stimulating participation of public healthcare “They have a high level of satisfaction,” Román
system users. Minister Geli pointed to the acknowledged, “a figure that demonstrates a
following possibilities for doing this: good level of co-operation between the public
decentralization of services, granting entry to and private.” Even so, with a view to the future,
municipalities; restructuring the salary policy, she identified some areas for improvement, such
linking it to concrete objectives, or the as establishing standards of good practices for
improving the drug offering, stepping up all service providers; educating the patient
pharmaceutical innovation and investment. about limiting the freedom of frequency;
“If the rules of the game are clear, the private reinforcing the role of doctors from private
and public model can coexist and even practices; and their acting as a stimulating agent
co-operate extensively. It all depends on of services offered.
optimizing present resources. Professionals The next speaker was Boi Ruiz, the Director
and users must become involved in order to of the Unió Catalana d’Hospitals (the Catalan
impact the quality of the system and Union of Hospitals), who suggested that the
guarantee its sustainability.”
The Need for Public and Private
Co-operation
An interesting experience was offered toward
midday, guided by the Barcelona Pompeu Fabra
University’s Director of the Center for Economy
and Health, Dr. Guillem López Casasnovas. He
suggested that the participants of the same
round table respond to the questions opened
by the last presentation: how to manage the
differential between social benefit and welfare
acts; what sort of development might be
expected from complementary healthcare
expenditure; why is it so difficult to define a
first-rate public catalogue; and what possible
forms of co-operation could there be between
the private and public systems?
The first to respond to this series of
questions was Enric Agustí, the Sub Director
of the Servei Català de la Salut (Catalan Health
Service), for whom the two key issues were Sub Director of the Catalan Health Service, Enric Agustí; Lavinia-ASISA’s delegate in
that of decentralization and co-payment. In Barcelona, Dr. Antonia Solvas; Director of the Research Center for Health Economics at the
Universitat Pompeu Fabra in Barcelona, Dr. Guillem López Casasnovas; General Director of
his opinion, healthcare expenses will continue
MUFACE, Carmen Román; Director of the Catalan Union of Hospitals, Boi Ruiz; and former
to grow even if the number of insured does SCIAS president, Lluís M. Rodà.
JULY AUGUST SEPTEMBER 2005 35

3. current context of growing demand reveals a Swedish healthcare system are the association
series of dysfunctions that are common to the of systems to specific regions, the reduction
surrounding countries. Generally speaking, of primary-care centers and hospitals (even if
what is lacking is a mayor investment, but above they are large) or the volume of subcontracts
all, better management. The organizational (even though as they are more effective). In
decisions are basic, and in this context, the this context of growing privatization, the main
contribution of the private system toward actors are the lobby groups formed by co-
reducing the public expenditure is evident. operatives of professionals or members of
The third person to contribute was Dr. various types (children, the elderly, etc.), the
Antonia Solvas, Lavinia-ASISA’s delegate in total of which already numbers 1200. This
Barcelona, who spoke for the health co- subcontracting trend, begun in the 1990s, has
operative’s professionals. According to her, the caused a growth of the sector, which has gone
Dr. José C. Guisado, private system offers speed, quality and personal from some 45,000 to 100,000 workers. Medico-
IHCO President.
attention to the public, for which reason, the op stands out amongst these initiatives, a co-
two models must work together to improve the operative of doctors founded in 1998 in
overall system. This implies introducing more Stockholm to attend to the varying healthcare
effective forms of business management, greater realities in Sweden. It is one example of
adaptability on the part of professionals to the collaboration between the public and private
new structures and patient demand as well as healthcare systems, participating in the public
more effective use of the system by patients. The system as a subcontractor and is characterized
issue will be knowing to establish the by the qualitative relationship between
appropriate degree of complementarity and the patients and members and the influence of
framework for such co-operation, taking into preventative medicine and nutrition.
account that there are already 8.8 million health Coming from the point furthest away from
policyholders in Spain. Barcelona was the experience of the Japanese
The last word went to the former president Association of Healthcare Co-operatives,
of SCIAS, Lluis M. Rodá, who was there as the presented by its vice President, Dr. Hiroshi Ono.
representative of the health co-operative Japan presently has some 600 user co-operatives,
members. He suggested that users need to 119 of which are healthcare co-operatives, which
participate fully in the healthcare system’s service 2.4 million people. Users can become
debates as well as its management, and not only workers, a phenomenon that frequently occurs
in times of illness, but rather, to the contrary. because their knowledge and experience of
He offered the example of SCIAS, where doctors making decisions is highly valued. Their
and members jointly fix the rates of the facilities include 78 hospitals, 295 clinics and
premiums and the reimbursements. The mixed 50 odontological centers; the largest of which
system he proposes is a possible means for have between 300 and 400 beds. They mostly
avoiding both the system’s collapse and user provide primary and hospital care, although
frustration. Nonetheless, he set an even higher their services to the home and the courses they
goal, aspiring not just to quotas being tax offer on learning self-diagnosis and prevention
deductible but also freedom of choice. “It is are also highly valued. The Japanese co-
appropriate to a democratic system. Courage is operatives belong to APHCO, the Asia-Pacific
required to extend the formula of healthcare Healthcare Co-operatives Organization. Their
co-operatives to the whole of society,” he future depends on increasing users and
affirmed. improving participation and management
although competition will doubtlessly increase
Rebuilding the Puzzle of Healthcare as well.
Co-operatives The next speaker came from the opposite
In the afternoon, Dr. José Carlos Guisado’s end of the globe, Dr. Ricardo López, president
presentation was followed by a round table of the Argentinean Federation of United
Minister of Employment and exploring the various experiences of healthcare Health Organizations (Federación Argentina
Industry in the Catalan Government,
co-operatives around the world, involving the de Entidades Solidarias de Salud). His
Josep M. Rañe, Josep M. Rañé
and Alejandro Barahona, General participation of five speakers from a range of presentation began by analyzing the socio-
Subdirector of Promotion of the geographies and contexts. economic situation of his country, which
Social Economy in Spain, Alejandro
The first of these was the President of following the crisis of 2001, has left some 40%
Barahona.”
Medico-op (Sweden), Per-Olof Jonson, who of its population in poverty (17% of these in
explained that the primary tendencies of the extreme poverty) and has reduced health
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4. spending from 700 to 253 dollars per person. was a difficult relationship between the public
Healthcare is one of the few public services that and private systems, as well as a competitive
had escaped the wave of privatization by the incursion by the pharmaceutical sector and a
Argentinean government during the 1990s, due lack of preventative medicine. The solution
in large part to the fact that head doctors had was to create co-operatives that offered non-
made sure to limit access to services. As a result, covered services to communities, implicating
some 50% of the population does not have the same community or other auxiliary co-
healthcare coverage, while infant mortality has operatives (ambulances, etc.) and in this way
grown from 16.3 to 16.8 per thousand. It was in generating a new culture of health.
this context that healthcare co-operatives Finally, the last speaker was Josep
appeared as a necessity and an alternative. M. Reygosa, the President of SCIAS, who
FAESS (the Argentinean Federation of Health emphasized that the State has gradually been Josep M. Reygosa,
SCIAS President
and Welfare Establishments or Federación increasing its role in all arenas up to the
Argentina de Establecimientos Sanitarios de point of disinvesting some of their private
Salud) was founded in 1999, its members initiative. Despite everything, in others, this
proceeding from co-operatives in other fields has not accompanied by a corresponding
(electricity, water, telephone services, etc.) and increase in the quality of services. These were
their respective professionals, from mutual the circumstances in which Autogestió-ASC
societies and other entities in crisis. They and Lavinia-ASISA were created. Later, given
currently dispose of four primary care centers. the scarcity of hospital beds and the poor
Representing Canada was Martin van der quality of the existing ones, SCIAS was
Borre, Director of Development for the Aylmer founded. Today, this co-operative includes
Health Co-operative, a project initiated in 2004 170,000 consuming members and more than
on the basis of the experience of one clinic in 800 employees. Autogestió-ASC and Lavinia-
existence since 1997. This rudimentary ASISA are co-managed by an entity that does
hospital center, owned by several doctors, was not yet have a legal structure: the Group
transformed into a co-operative of doctors, Commission (Comissió de grup). Spain’s
users and works to offer services to a healthcare sector is presently facing
community of 40,000. In Quebec there are challenging times. Public medicine is hard-
1500 private clinics that offer, above all, pressed to guarantee its services, while the
primary care services. But this model began option of co-payment, despite its lack of
to slacken due to a reorganization of the popularity, appears to be the solution. But
public system in accordance to criteria of that’s not the point, because the State should
centralization and the low participation of place even more value on the role of
users, which caused in Montreal alone the co-operatives, which are compatible with any
closing of 60 clinics. At the same time, there other system.
President of the Argentinean Federation of United Health Organizations, Dr. Ricardo López; President of SCIAS,
Josep M. Reygosa.; President of Medico-op (Sweden), Per-Olof Jonson; vice-President of the Japanese Association
of Healthcare Co-operatives, Dr. Hiroshi Ono; and Director of Development for the Aylmer Health Co-operative, Martin
van der Borre.
JULY AUGUST SEPTEMBER 2005 37

5. Sharing the Co-operative Methodology where health care coverage is less than
The second day’s proceedings of the Seminar adequate.
began with another round table looking at the Next up was Geraint Day, representative
experiences of healthcare co-operatives around from Co-operatives UK and a member of the
the world, in which five speakers elaborated Executive Committee of the Co-operative Party.
on how healthcare co-operatives can be adapted His presentation explained that British
to the needs of any socio-economic context. healthcare is dominated by the NHS (the
The first speaker was the representative National Health Service), which employs 1.3
from the Canadian Council for Co-operation, million people and controls 75% of spending,
Jean Pierre Girard, who explained that the while the private sector brings together 750,000
healthcare sector is perhaps one of the less- and controls the remaining 25%. Even so, the
developed branches of the co-operative tree latter accounts for 18% of the hospitals. The co-
in Canada. In fact, the Canadian healthcare operative sector in the UK is very diverse and
model, modeled on the British, is based on a includes medical, pharmaceutical and pediatric
public service (state and federal) that co-operatives, amongst others. The medical co-
facilitates access to universal and free operatives, such as SELDOC, tend to be out-of-
healthcare. Notwithstanding, in recent years, hours organizations in which professionals
federal governments, which are responsible perform part-time. Having realized that the NHS
for half of healthcare expenditure, have was too big to function as a centralized
dramatically limited their investment. This organization, the Ministry of Health began
has been the context for the emergence decentralizing its services in 2000 toward
co-operatives in certain areas, especially hospital foundations and in this way opened an
those offering primary care services and avenue of co-operation with the private sector.
preventative medicine, some of which include As of April 2005, these foundations already
physicians and patients (in areas like Regina, numbered 31, a figure expected to double over
Saaskewatch and Prince Albert). Their growth the year. Day also described the activities of Co-
results from providing services in rural areas operatives UK, which is a member of the Care
The Co-operative Experience of Autogestió-ASC
shareholders are today’s co-operative partners. participative norms, with the final goal of
Melcior Ros This experience was replicated nationally with providing a high level of social medicine.
the creation, first, of the Insurance Company Doctors are able to practice their profession
ASISA and the constitution –further on - of the with full liberty, while patients enjoy a high
doctors’ co-operative society Lavinia. level of social medicine. In turn, they are
Especially interesting for attendees of the round
Later, in 1988, Grup Assistència, was themselves grouped into a co-operative (SCIAS)
table on the realities and experiences of
developed as an offshoot of Autogestió-ASC, that allows them to self-manage the healthcare
healthcare co-operatives around the world, was
thanks to combined efforts with Societat Co- facilities needed to develop this social
Dr. Gerard Martí presentation of the case of
operativa d’Instal.lacions Assistencials healthcare system.
Autogestió-Assistència Sanitària Col.legial. As
Sanitàries (SCIAS); a co-operative society of users As Dr. Marti demonstrated in his
one of the first organizations founded by Dr.
created by the Dr. Espriu in the 70s, who had presentation, the figures available speak
Josep Espriu, it became very clear that it is one
just inaugurated the Barcelona Assistència. But eloquently. At present, Autogestió-ASC partners
of the maximum exponents of his healthcare
things would not end here. Just a year later, in consist of 5300 doctors (4330 of them active)
system.
1989, Autogestió-ASC, Lavinia-ASISA and SCIAS and 194 insured (170,000 of whom are SCIAS
Dr. Martí, member and secretary of
would join together to support the Espriu partners), and counts with 210 employees. It
Autogestió-ASC’s Consell Rector (Governing
Foundation for promoting healthcare co- disposes of 20 offices in Barcelona, the services
Council) and chief executive of the Foundation
operativism throughout the whole world. of Barcelona Hospital and the emergency home
Espriu, began by explaining the project’s
Today, other organizations like Biopat, CECOEL service provider SUD (Servei d’Urgencies
genesis. In 1960, sponsored by the Barcelona
and the Montepío doctor Luis Sans Solá form Domiciliàries) – both managed by SCIAS, and
Medical Association, Dr. Espriu decided to create
part of the group. Dr. Martí, who is the Medical has convened agreements with ASISA and CASS,
an insurance company based on
Sub director of Barcelona Hospital, went on to the Andorran Social Security Service. It allocates
the “igualatorio” model to establish the
explain some of the elements shaping more than half of its income toward
foundations of his system of social medicine.
Autogestió-ASC, which in the present moment remunerating its physicians, and being a non-
However, that new entity, Assistència Sanitària
leads the private health sector in Catalonia. profit, its surplus is reinvested back into the
Col.legial, required by law to have a managerial
Policyholders can choose their doctor freely organization itself.
character, did not provide the best fit for Dr.
from amongst Autogestió associates, who in Thanks to all these factors, this
Espriu’s ambitions.
turn receive payment for each professional organization presently leads the Catalan private
In 1978, he encouraged the doctors who
service rendered. Costs are covered by health sector in what is a very competitive
were his shareholders to constitute a co-
premiums paid by the users, though also they market (62 entities) in a wide segment (21.28 of
operative society that allowed them to self-
participate – through a payment that is largely the population). In summary, as Dr. Marti
organize and be the protagonists of their own
symbolic – with the voucher they present for reminded us, the 14% of all Catalans who rely
profession, advocating quality, personalized
every visit. on Autogestió-ASC do so with a high degree of
medical attention. Thus, Autogestió was born,
The system’s mission is none other than to loyalty and satisfaction, a trait they share with
38 doctors’ co-operative society that since then
the
involve medical professional and users in the
has governed the direction of ASC. Its the same physicians who offer their services as
same system, governed by democratic and partners.

6. Working Group (a leader in private medicine),
which participates in the Co-operative Party and
in Mutuo, its public-private publication.
The next to speak was Dr. Almir Gentil,
UNIMED’s Director of Marketing and
Development, who dealt with the issue of social
welfare co-operatives in Brazil and analyzed the
keys to success in what has been one of the
major co-operative experiments in South
America.
His presentation was followed by that of
Dr. Jagdev Singh Deo, President of the Doctor’s
Co-operative of Malaysia, a country whose
health system went into crisis in 1985 due to the oncology and magnetic resonance units,
the increase in the healthcare bill. Their and later, the computer systems. The second
process, driven by the opposition from the stage, which is currently underway, involves the
physicians, forced the Government to make construction of public hospitals by private
sure that the NHFS supplement their services initiatives, as in the cases of La Ribera (Alzira)
with those of the private sector, by means of and Torrevieja. The participation of the
an organization such as the National Co- Administration, which pays according to the
operatives Policy. Currently, the healthcare number of assigned healthcare targets, is
sector is the third in the country, with more guaranteed by the figure of the Comissionat,
than 4000 entities, the numerous hospital co- while the private sector is responsible for
operatives that service specific communities. structuring the system. There are only two
Their model is based on guidelines established exceptions: healthcare prostheses and primary
by Dr. Espriu for mixed co-operatives of care pharmaceutical spending.
professionals and users, something that Dr. Miquel Vilardell, Professor of Medicine
facilitates more extensive and the best possible at the Universitat Autónoma de Barcelona and
quality of service. In its own right, the Doctor’s Department Head of Internal Medicine at the
Co-operative of Malaysia was one of the Vall d’Hebron Hospital was the last speaker. His
pioneers, founded in 1957 in the urban area presentation shared some of the indicators that
of Media, and later expanding to the country’s can be used for comparing the private and
rural zones. public health models, such as waiting lists,
The round table concluded with the service level, the existence of teaching efforts,
participation of Dr. Gerard Martí, spokesman the completion of research, the types of
for Autogestió-ASC’s Consell Rector (governing structures, motivation, incentives, and ongoing
council), who analyzed the development and training for professionals, and user satisfaction.
circumstances of one of the entities He used these same measures in his recent
championed by Dr. Josep Espriu. report on health in Catalonia, an experience
Creative Formulas for Co-operation
After the presentation given by Dr. Reinhard
Busse about the various healthcare systems in
Europe, the latter half of the morning continued
with a round table exploring the various forms
of co-operation between private organizations
in the public healthcare systems, which was
initiated brilliantly by Dr. Francisco Ivorra,
President of Lavinia-ASISA.
He was followed by Dr. Julio F. de España,
President of the Corts Valencianes, who
explained how the Valencia Government opened
the door to participation in the national health Geraint Day, representative from Co-operatives UK and member of the Executive Committee
sector by the private sector in 1997, with the of the Co-operative Party; Secretary of the Consell Rector for Autogestió-ASC, Dr. Gerard Martí;
the representative from the Canadian Council for Co-operation, (Canada), Jean Pierre Girard; ;
objective of improving healthcare services. It Director of Marketing & Development for UNIMED in Brasil, Dr. Almir Gentil; and President
was a gradual process of outsourcing, first of of the Doctors Co-operative of Malaysia Dr. Jagdev Singh Deo.
J U L I O L AG O S T S E T E M B R E 2 0 0 5 39

7. IHCO President, Dr. José C. Guisado; President of the Corts Valencianes, Dr. Julio F. de España; Lavinia-ASISA
President, Dr. Francisco Ivorra; and Dr. Miquel Vilardell, Professor of Medicine at the Barcelona Universitat
Autònoma de Barcelona and Head of Internal Medicine Services at the Hospital de la Vall d’Hebron.
which has led him to assert that the fact that The final presentations were of an
the public system functions can be largely institutional character, evidence of the
attributed to the existence of the private participation of representatives from these
sector. As regards the future, the main debates same administrations. Hence, Alejandro
will revolve around the Administration’s Barahona, General Subdirector of Promotion
ability to maintain a universal system or on of the Social Economy in Spain pointed out that
the expectations placed on citizens. Both health systems are linked to their societies, and
professionals and users must participate in as a consequence, are also affected by social
these debates. change. Thus, the most recent developments
pose questions about the viability of the public
Multiple Challenges, Great Potential system, a situation in which health co-
The closing session took place shortly before operatives can play an important role. In this
noon, in which the President of the Espriu sense, it seems appropriate to advocate their
Foundation, Dr. Josep O. Gras, expressed his greater involvement in the national health
appreciation for the number and quality of the system to adapt resources and needs, as was
contributions made, which he considered as recently recommended by the European Union.
another indicator of the level of participation Lastly, the Minister of Employment and
that forms the foundation of the co-operative Industry in the Catalan Government, Josep M.
movement. Rañe, described social economy as the sector
According to Dr. José C. Guisado, of the future and as an efficient and democratic
IHCO President, the Seminar’s primary formula for combining collective interest,
contribution was the (bringing closer) of solidarity, participation and responsibility.
methodologies for collaboration between the Advanced societies require the participation of
private and public systems, while always its citizens in all arenas, especially those sectors
remembering that society is the ultimate related to people. In fact, no business activity
beneficiary and that the common objective makes sense if it does not have an impact on
should be to offer service. Gabriela Sozanski, people’s quality of life. And herein lies the
ACI director for Knowledge Management, spoke importance that co-operatives have in offering
along these same lines, emphasizing the solutions to health and social welfare problems,
versatility of co-operatives in offering equally those very same ones in which the
valid solutions in varying socio-economic Administration is asking for help. The
contexts and she recognized the willingness of International Seminar on Healthcare and
ACI’s Director for
Knowledge Management, the administrations in seeking a joint solution Co-operatives has been a magnificent
Gabriela Sozanski. to a problem that affects us all. demonstration of this outlook.
40 monograph | compartir |

8. ASISA Shares Its Experience
Elvira Palencia
The president of ASISA, Dr. Francisco Ivorra, healthcare provisions and creating its own
participated in a round table held during the healthcare infrastructure. This has also allo-
second day of the Seminar analyzing the colla- wed them to manage its own healthcare costs
boration of private entities in the Healthcare and offer high quality assistance to its asso-
Dr. Francisco Ivorra,
National System. His presentation offered a ciates despite inappropriate procedures for President of Lavinia-ASISA.
view of ASISA’s experience. updating premiums.
Doctor Ivorra began by explaining ASISA’s cre- ASISA has also been able to generate a network
ation in the late sixties, as one of Dr. Espriu’s of healthcare centers that includes 15 of its
initiatives to offer physicians from all the own hospitals and 1 participant, in ad the
Spanish provinces a way of participating in a polyclinics and the diagnosis centers and
new formula for organizing healthcare acti- extra-hospitalary treatment that are immer-
vity; one that would allow them to offer qua- sed in an Integral Credentials Quality Plan of
lity healthcare assistance based on a direct all its units and services.
doctor-patient relationship, as well as enjoy
greater independence in the exercise of their Traditionally, the centers focused on meeting
profession. the needs of ASISA associates, but they are
currently following a policy to gradually diver-
The President of ASISA pointed out the fact sify its activity and becoming suppliers of spe-
that ASISA has been collaborating with the cialized attention for the healthcare services
public healthcare system for more than 30 of the different autonomous regions.
years through the agreements with the three
governmental mutual societies: MUFACE, During 2004, income from public sector agre-
MUJEJU (General Judicial Mutual Society), and ements was about 10 million euros.
ISFAS (Armed Forces Social Institute). In addi- Additionally, ASISA, Dr. Ivorra went on to
tion, ASISA co-operates with the Public explain, co-operates with the Administration
Healthcare System in numerous healthcare in new management initiatives that are
service agreements. currently being promoted in the Public
Healthcare System.
The advantages they offer are well demons-
trated by the fact that civil servants are the The Torrevieja Project is one example of this.
only Spanish workers that can choose betwe- The Valencian Government has adjudicated
en public and private healthcare services the project – under administrative concession,
(more than 85% choose private medicine). The which means public ownership but private
reason is that -- besides having a guaranteed management – to a temporary joint group of
and improved healthcare coverage with bene- companies (UTE) formed by a financial part-
fits officially approved by the Healthcare ner (Bancaixa and CAM), an expert (ASISA) and
Public System – they enjoy other advantages a construction partner. Thus, using this for-
such as free choice of center and professional mula can generate mutual society services at
(both in primary assistance as well as specia- a local level.
lized), no delays in access, and a single room
with an additional bed for a companion. The project involves the construction of a
public hospital in Torrevieja (Alicante) and the
The company’s chief executive explained that integral management of healthcare provision
even though ASISA is the main supplier of in Area 20 of the Valencian Community. The
healthcare assistance for the three groups, it project would be managed by ASISA as the
has been able to grow without generating total expert partner once the Hospital initiates its
dependence on the public mutualism, due to activity next year. This concession, contracted
its position as a company that owns a physi- for a specific period of time (from 15 to 20
cians’ co-operative. This has allowed the com- years), reverts back to the Administration once
pany to reinvest its profits into improving this period is over.
JULY AUGUST SEPTEMBER 2005 41