health co-operatives conference, barcelona

Report on the International Seminaron Healthcare and Co-operativesSergi Rodríguez

34 monograph | compartir |

number of years ago, a well-known international hotelchain began construction onone of Barcelona’s principalavenues to hold their firstestablishment in the city,with which they hoped to

make their entry into the Spanish market.Owing to problems with administrative permits,the project was never completed, and thatimposing structure on Diagonal ended uphousing Barcelona Hospital.

While it could seem like a paradox, itisn’t. All these years later, as destiny wouldhave it, the Hilton Hotel provided the site foran important event in the world of health co-operatives: the International Seminar onHealthcare and Co-operatives, sponsored byan organization none other than the EspriuFoundation, one of whose Board members isthe same entity (SCIAS) that took over theconstruction of the Barcelona Hospital.

And it was appropriate to the occasion.During two entire days, 200 co-operativeleaders, institutional representatives andfield experts convened to discuss the globalevolution of health co-operatives and thecurrent situation of various public healthcaresystems. The gathering attested to theincreasing role co-operation between privateand public models has assumed with thefinality of guaranteeing quality attention tocitizens.

The high level meeting, which marked amilestone in the recent history of health co-operatives, began first thing in the morningon the 20th with the official opening of theSeminar. Dr. Josep Oriol, president of theEspriu Foundation, began the proceedingsby welcoming everyone and recognizing the“debt we all owe to Dr. Josep Espriu.” He

emphasized, “The need for creating synergiesusing this social healthcare model invites usall to analyze which forms of collaborationare possible with the public system, to theend of ensuring their viability.” Shortly after,he read aloud a letter from Pasqual Maragall,President of the Catalan Government.

The next speaker was the ACI director forKnowledge Management, Gabriela Sozanski,who pointed to “the enormous potential forco-operation between administrations and co-operatives initiating activity in this socio-economic reality,” while in his turn, the president of the International Health Co-operatives Organization (IHCO), José CarlosGuisado, reminded everyone of the importanceto “not lose sight of our common goal to offerthe best possible service to citizens, who arethe ultimate beneficiaries of the healthcaresystem.” Next came the turn of AlfonsoJiménez, Director General of the Cohesion deSNS of the Ministry of Labor and SocialWelfare, for whom “health care organizations,by virtue of their very nature, (are bound) havean inherent social responsibility that obligesthem to supplement and enrich today’s publichealthcare systems.”

Goal: Guarantee the Level of ServiceThe inaugural session of the Seminar waspresided over by the Health Minister for theCatalan Government, Marina Geli, whopointed out the historical importance co-operatives have had in the country: “Theyfound fertile ground in the Catalan civilsociety, whose same dynamism had previouslydrove the trade union, mutual societies andcharities movements,” she said.

She continued with an analysis of thecurrent structure of the healthcare system,whose origins should be traced to the 1981

ADr. Josep O. Gras,

President of the Espriu

Foundation, welcomed the

participants to the Seminar.

Alfonso Jiménez, Director

General of the Cohesion de

SNS of the Ministry of Labor

and Social Welfare.

35J U L Y A U G U S T S E P T E M B E R 2 0 0 5

legislative reforms that first established ahealthcare system of a public character albeitone with different provisions, in which “theprivate healthcare model began to assume acomplementary role. Let’s not forget that 24%of all Catalans have private insurance.” Thisnew framework was finalized in 1986 with the subsequent reform that established afinancing model that relied more upon taxesthan quotas. However, over the years, one ofthe model’s characteristic features—universalaccess – has been ultimately responsible forcollapsing the system, or depersonalizing it(feeling more like a user of the system ratherthan an owner), or magnifying it (placing toomany expectations).

The major challenge would be that ofstimulating participation of public healthcaresystem users. Minister Geli pointed to thefollowing possibilities for doing this:decentralization of services, granting entry tomunicipalities; restructuring the salary policy,linking it to concrete objectives, or theimproving the drug offering, stepping uppharmaceutical innovation and investment.“If the rules of the game are clear, the privateand public model can coexist and even co-operate extensively. It all depends onoptimizing present resources. Professionalsand users must become involved in order toimpact the quality of the system andguarantee its sustainability.”

The Need for Public and Private Co-operationAn interesting experience was offered towardmidday, guided by the Barcelona Pompeu FabraUniversity’s Director of the Center for Economyand Health, Dr. Guillem López Casasnovas. Hesuggested that the participants of the sameround table respond to the questions openedby the last presentation: how to manage thedifferential between social benefit and welfareacts; what sort of development might beexpected from complementary healthcareexpenditure; why is it so difficult to define afirst-rate public catalogue; and what possibleforms of co-operation could there be betweenthe private and public systems?

The first to respond to this series ofquestions was Enric Agustí, the Sub Directorof the Servei Català de la Salut (Catalan HealthService), for whom the two key issues werethat of decentralization and co-payment. Inhis opinion, healthcare expenses will continueto grow even if the number of insured does

not. This makes it necessary to “know how toidentify needs and how to address them inorder to avoid frustration on the part of bothprofessionals and patients. The public modelneeds the private when it comes to waitinglists and state-of-the-art medical equipment,”Agustí said.

Next, Carmen Román, Director General ofMUFACE (the General Mutual Society of StateCivil Servants) described their unique modelthat combines the public and private.Essentially, 2.5 million members throughoutSpain enrolled in MUFACE have their own SocialSecurity plan that allows them to chooseservices offered by either public or privateproviders. Some 86.5% of them choose the latteroption, through five contracted companies.“They have a high level of satisfaction,” Románacknowledged, “a figure that demonstrates agood level of co-operation between the publicand private.” Even so, with a view to the future,she identified some areas for improvement, suchas establishing standards of good practices forall service providers; educating the patientabout limiting the freedom of frequency;reinforcing the role of doctors from privatepractices; and their acting as a stimulating agentof services offered.

The next speaker was Boi Ruiz, the Directorof the Unió Catalana d’Hospitals (the CatalanUnion of Hospitals), who suggested that the

The opening address was given by

the Catalan Government’s Minister

of Health, Marina Geli

Sub Director of the Catalan Health Service, Enric Agustí; Lavinia-ASISA’s delegate inBarcelona, Dr. Antonia Solvas; Director of the Research Center for Health Economics at theUniversitat Pompeu Fabra in Barcelona, Dr. Guillem López Casasnovas; General Director ofMUFACE, Carmen Román; Director of the Catalan Union of Hospitals, Boi Ruiz; and formerSCIAS president, Lluís M. Rodà.


current context of growing demand reveals aseries of dysfunctions that are common to thesurrounding countries. Generally speaking,what is lacking is a mayor investment, but aboveall, better management. The organizationaldecisions are basic, and in this context, thecontribution of the private system towardreducing the public expenditure is evident.

The third person to contribute was Dr.Antonia Solvas, Lavinia-ASISA’s delegate inBarcelona, who spoke for the health co-operative’s professionals. According to her, theprivate system offers speed, quality and personalattention to the public, for which reason, thetwo models must work together to improve theoverall system. This implies introducing moreeffective forms of business management, greateradaptability on the part of professionals to thenew structures and patient demand as well asmore effective use of the system by patients. Theissue will be knowing to establish theappropriate degree of complementarity and theframework for such co-operation, taking intoaccount that there are already 8.8 million healthpolicyholders in Spain.

The last word went to the former presidentof SCIAS, Lluis M. Rodá, who was there as therepresentative of the health co-operativemembers. He suggested that users need toparticipate fully in the healthcare system’sdebates as well as its management, and not onlyin times of illness, but rather, to the contrary.He offered the example of SCIAS, where doctorsand members jointly fix the rates of thepremiums and the reimbursements. The mixedsystem he proposes is a possible means foravoiding both the system’s collapse and userfrustration. Nonetheless, he set an even highergoal, aspiring not just to quotas being taxdeductible but also freedom of choice. “It isappropriate to a democratic system. Courage isrequired to extend the formula of healthcareco-operatives to the whole of society,” heaffirmed.

Rebuilding the Puzzle of Healthcare Co-operativesIn the afternoon, Dr. José Carlos Guisado’spresentation was followed by a round tableexploring the various experiences of healthcareco-operatives around the world, involving theparticipation of five speakers from a range ofgeographies and contexts.

The first of these was the President ofMedico-op (Sweden), Per-Olof Jonson, whoexplained that the primary tendencies of the

Swedish healthcare system are the associationof systems to specific regions, the reductionof primary-care centers and hospitals (even ifthey are large) or the volume of subcontracts(even though as they are more effective). Inthis context of growing privatization, the mainactors are the lobby groups formed by co-operatives of professionals or members ofvarious types (children, the elderly, etc.), thetotal of which already numbers 1200. Thissubcontracting trend, begun in the 1990s, hascaused a growth of the sector, which has gonefrom some 45,000 to 100,000 workers. Medico-op stands out amongst these initiatives, a co-operative of doctors founded in 1998 inStockholm to attend to the varying healthcarerealities in Sweden. It is one example ofcollaboration between the public and privatehealthcare systems, participating in the publicsystem as a subcontractor and is characterizedby the qualitative relationship betweenpatients and members and the influence ofpreventative medicine and nutrition.

Coming from the point furthest away fromBarcelona was the experience of the JapaneseAssociation of Healthcare Co-operatives,presented by its vice President, Dr. Hiroshi Ono.Japan presently has some 600 user co-operatives,119 of which are healthcare co-operatives, whichservice 2.4 million people. Users can becomeworkers, a phenomenon that frequently occursbecause their knowledge and experience ofmaking decisions is highly valued. Theirfacilities include 78 hospitals, 295 clinics and50 odontological centers; the largest of whichhave between 300 and 400 beds. They mostlyprovide primary and hospital care, althoughtheir services to the home and the courses theyoffer on learning self-diagnosis and preventionare also highly valued. The Japanese co-operatives belong to APHCO, the Asia-PacificHealthcare Co-operatives Organization. Theirfuture depends on increasing users andimproving participation and managementalthough competition will doubtlessly increaseas well.

The next speaker came from the oppositeend of the globe, Dr. Ricardo López, presidentof the Argentinean Federation of UnitedHealth Organizations (Federación Argentinade Entidades Solidarias de Salud). Hispresentation began by analyzing the socio-economic situation of his country, whichfollowing the crisis of 2001, has left some 40%of its population in poverty (17% of these inextreme poverty) and has reduced health

Minister of Employment and

Industry in the Catalan Government,

Josep M. Rañe, Josep M. Rañé

and Alejandro Barahona, General

Subdirector of Promotion of the

Social Economy in Spain, Alejandro

Barahona.”

Dr. José C. Guisado,

IHCO President.


spending from 700 to 253 dollars per person.Healthcare is one of the few public services thathad escaped the wave of privatization by theArgentinean government during the 1990s, duein large part to the fact that head doctors hadmade sure to limit access to services. As a result,some 50% of the population does not havehealthcare coverage, while infant mortality hasgrown from 16.3 to 16.8 per thousand. It was inthis context that healthcare co-operativesappeared as a necessity and an alternative.FAESS (the Argentinean Federation of Healthand Welfare Establishments or FederaciónArgentina de Establecimientos Sanitarios deSalud) was founded in 1999, its membersproceeding from co-operatives in other fields(electricity, water, telephone services, etc.) andtheir respective professionals, from mutualsocieties and other entities in crisis. Theycurrently dispose of four primary care centers.

Representing Canada was Martin van derBorre, Director of Development for the AylmerHealth Co-operative, a project initiated in 2004on the basis of the experience of one clinic inexistence since 1997. This rudimentaryhospital center, owned by several doctors, wastransformed into a co-operative of doctors,users and works to offer services to acommunity of 40,000. In Quebec there are1500 private clinics that offer, above all,primary care services. But this model beganto slacken due to a reorganization of thepublic system in accordance to criteria ofcentralization and the low participation ofusers, which caused in Montreal alone theclosing of 60 clinics. At the same time, there

was a difficult relationship between the publicand private systems, as well as a competitiveincursion by the pharmaceutical sector and alack of preventative medicine. The solutionwas to create co-operatives that offered non-covered services to communities, implicatingthe same community or other auxiliary co-operatives (ambulances, etc.) and in this waygenerating a new culture of health.

Finally, the last speaker was Josep M. Reygosa, the President of SCIAS, whoemphasized that the State has gradually beenincreasing its role in all arenas up to thepoint of disinvesting some of their privateinitiative. Despite everything, in others, thishas not accompanied by a correspondingincrease in the quality of services. These werethe circumstances in which Autogestió-ASCand Lavinia-ASISA were created. Later, giventhe scarcity of hospital beds and the poorquality of the existing ones, SCIAS wasfounded. Today, this co-operative includes170,000 consuming members and more than800 employees. Autogestió-ASC and Lavinia-ASISA are co-managed by an entity that doesnot yet have a legal structure: the GroupCommission (Comissió de grup). Spain’shealthcare sector is presently facingchallenging times. Public medicine is hard-pressed to guarantee its services, while theoption of co-payment, despite its lack ofpopularity, appears to be the solution. Butthat’s not the point, because the State shouldplace even more value on the role of co-operatives, which are compatible with anyother system.

Josep M. Reygosa,

SCIAS President

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.

Sharing the Co-operative MethodologyThe second day’s proceedings of the Seminarbegan with another round table looking at theexperiences of healthcare co-operatives aroundthe world, in which five speakers elaboratedon how healthcare co-operatives can be adaptedto the needs of any socio-economic context.

The first speaker was the representativefrom the Canadian Council for Co-operation,Jean Pierre Girard, who explained that thehealthcare sector is perhaps one of the less-developed branches of the co-operative treein Canada. In fact, the Canadian healthcaremodel, modeled on the British, is based on apublic service (state and federal) thatfacilitates access to universal and freehealthcare. Notwithstanding, in recent years,federal governments, which are responsiblefor half of healthcare expenditure, havedramatically limited their investment. Thishas been the context for the emergence co-operatives in certain areas, especially those offering primary care services andpreventative medicine, some of which includephysicians and patients (in areas like Regina,Saaskewatch and Prince Albert). Their growthresults from providing services in rural areas

where health care coverage is less thanadequate.

Next up was Geraint Day, representativefrom Co-operatives UK and a member of theExecutive Committee of the Co-operative Party.His presentation explained that Britishhealthcare is dominated by the NHS (theNational Health Service), which employs 1.3million people and controls 75% of spending,while the private sector brings together 750,000and controls the remaining 25%. Even so, thelatter accounts for 18% of the hospitals. The co-operative sector in the UK is very diverse andincludes medical, pharmaceutical and pediatricco-operatives, amongst others. The medical co-operatives, such as SELDOC, tend to be out-of-hours organizations in which professionalsperform part-time. Having realized that the NHSwas too big to function as a centralizedorganization, the Ministry of Health begandecentralizing its services in 2000 towardhospital foundations and in this way opened anavenue of co-operation with the private sector.As of April 2005, these foundations alreadynumbered 31, a figure expected to double overthe year. Day also described the activities of Co-operatives UK, which is a member of the Care

38

Especially interesting for attendees of the roundtable on the realities and experiences ofhealthcare co-operatives around the world, wasDr. Gerard Martí presentation of the case ofAutogestió-Assistència Sanitària Col.legial. Asone of the first organizations founded by Dr.Josep Espriu, it became very clear that it is oneof the maximum exponents of his healthcaresystem.

Dr. Martí, member and secretary ofAutogestió-ASC’s Consell Rector (GoverningCouncil) and chief executive of the FoundationEspriu, began by explaining the project’sgenesis. In 1960, sponsored by the BarcelonaMedical Association, Dr. Espriu decided to createan insurance company based on the “igualatorio” model to establish thefoundations of his system of social medicine.However, that new entity, Assistència SanitàriaCol.legial, required by law to have a managerialcharacter, did not provide the best fit for Dr.Espriu’s ambitions.

In 1978, he encouraged the doctors whowere his shareholders to constitute a co-operative society that allowed them to self-organize and be the protagonists of their ownprofession, advocating quality, personalizedmedical attention. Thus, Autogestió was born,the doctors’ co-operative society that since thenhas governed the direction of ASC. Its

shareholders are today’s co-operative partners.This experience was replicated nationally withthe creation, first, of the Insurance CompanyASISA and the constitution –further on - of thedoctors’ co-operative society Lavinia.

Later, in 1988, Grup Assistència, wasdeveloped as an offshoot of Autogestió-ASC,thanks to combined efforts with Societat Co-operativa d’Instal.lacions AssistencialsSanitàries (SCIAS); a co-operative society of userscreated by the Dr. Espriu in the 70s, who hadjust inaugurated the Barcelona Assistència. Butthings would not end here. Just a year later, in1989, Autogestió-ASC, Lavinia-ASISA and SCIASwould join together to support the EspriuFoundation for promoting healthcare co-operativism throughout the whole world.Today, other organizations like Biopat, CECOELand the Montepío doctor Luis Sans Solá formpart of the group. Dr. Martí, who is the MedicalSub director of Barcelona Hospital, went on toexplain some of the elements shapingAutogestió-ASC, which in the present momentleads the private health sector in Catalonia.

Policyholders can choose their doctor freelyfrom amongst Autogestió associates, who inturn receive payment for each professionalservice rendered. Costs are covered bypremiums paid by the users, though also theyparticipate – through a payment that is largelysymbolic – with the voucher they present forevery visit.

The system’s mission is none other than toinvolve medical professional and users in thesame system, governed by democratic and

participative norms, with the final goal ofproviding a high level of social medicine.Doctors are able to practice their professionwith full liberty, while patients enjoy a highlevel of social medicine. In turn, they arethemselves grouped into a co-operative (SCIAS)that allows them to self-manage the healthcarefacilities needed to develop this socialhealthcare system.

As Dr. Marti demonstrated in hispresentation, the figures available speakeloquently. At present, Autogestió-ASC partnersconsist of 5300 doctors (4330 of them active)and 194 insured (170,000 of whom are SCIASpartners), and counts with 210 employees. Itdisposes of 20 offices in Barcelona, the servicesof Barcelona Hospital and the emergency homeservice provider SUD (Servei d’UrgenciesDomiciliàries) – both managed by SCIAS, andhas convened agreements with ASISA and CASS,the Andorran Social Security Service. It allocatesmore than half of its income towardremunerating its physicians, and being a non-profit, its surplus is reinvested back into theorganization itself.

Thanks to all these factors, thisorganization presently leads the Catalan privatehealth sector in what is a very competitivemarket (62 entities) in a wide segment (21.28 ofthe population). In summary, as Dr. Martireminded us, the 14% of all Catalans who relyon Autogestió-ASC do so with a high degree ofloyalty and satisfaction, a trait they share withthe same physicians who offer their services aspartners.

The Co-operative Experience of Autogestió-ASC

Melcior Ros

39J U L I O L AG O S T S E T E M B R E 2 0 0 5

Working Group (a leader in private medicine),which participates in the Co-operative Party andin Mutuo, its public-private publication.

The next to speak was Dr. Almir Gentil,UNIMED’s Director of Marketing andDevelopment, who dealt with the issue of socialwelfare co-operatives in Brazil and analyzed thekeys to success in what has been one of themajor co-operative experiments in SouthAmerica.

His presentation was followed by that ofDr. Jagdev Singh Deo, President of the Doctor’sCo-operative of Malaysia, a country whosehealth system went into crisis in 1985 due tothe increase in the healthcare bill. Theirprocess, driven by the opposition from thephysicians, forced the Government to makesure that the NHFS supplement their serviceswith those of the private sector, by means ofan organization such as the National Co-operatives Policy. Currently, the healthcaresector is the third in the country, with morethan 4000 entities, the numerous hospital co-operatives that service specific communities.Their model is based on guidelines establishedby Dr. Espriu for mixed co-operatives ofprofessionals and users, something thatfacilitates more extensive and the best possiblequality of service. In its own right, the Doctor’sCo-operative of Malaysia was one of thepioneers, founded in 1957 in the urban areaof Media, and later expanding to the country’srural zones.

The round table concluded with theparticipation of Dr. Gerard Martí, spokesmanfor Autogestió-ASC’s Consell Rector (governingcouncil), who analyzed the development andcircumstances of one of the entitieschampioned by Dr. Josep Espriu.

Creative Formulas for Co-operationAfter the presentation given by Dr. ReinhardBusse about the various healthcare systems inEurope, the latter half of the morning continuedwith a round table exploring the various formsof co-operation between private organizationsin the public healthcare systems, which wasinitiated brilliantly by Dr. Francisco Ivorra,President of Lavinia-ASISA.

He was followed by Dr. Julio F. de España,President of the Corts Valencianes, whoexplained how the Valencia Government openedthe door to participation in the national healthsector by the private sector in 1997, with theobjective of improving healthcare services. Itwas a gradual process of outsourcing, first of

the oncology and magnetic resonance units,and later, the computer systems. The secondstage, which is currently underway, involves theconstruction of public hospitals by privateinitiatives, as in the cases of La Ribera (Alzira)and Torrevieja. The participation of theAdministration, which pays according to thenumber of assigned healthcare targets, isguaranteed by the figure of the Comissionat,while the private sector is responsible forstructuring the system. There are only twoexceptions: healthcare prostheses and primarycare pharmaceutical spending.

Dr. Miquel Vilardell, Professor of Medicineat the Universitat Autónoma de Barcelona andDepartment Head of Internal Medicine at theVall d’Hebron Hospital was the last speaker. Hispresentation shared some of the indicators thatcan be used for comparing the private andpublic health models, such as waiting lists,service level, the existence of teaching efforts,the completion of research, the types ofstructures, motivation, incentives, and ongoingtraining for professionals, and user satisfaction.He used these same measures in his recentreport on health in Catalonia, an experience

Geraint Day, representative from Co-operatives UK and member of the Executive Committee

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; ;

Director of Marketing & Development for UNIMED in Brasil, Dr. Almir Gentil; and President

of the Doctors Co-operative of Malaysia Dr. Jagdev Singh Deo.


which has led him to assert that the fact thatthe public system functions can be largelyattributed to the existence of the privatesector. As regards the future, the main debateswill revolve around the Administration’sability to maintain a universal system or onthe expectations placed on citizens. Bothprofessionals and users must participate inthese debates.

Multiple Challenges, Great Potential The closing session took place shortly beforenoon, in which the President of the EspriuFoundation, Dr. Josep O. Gras, expressed hisappreciation for the number and quality of thecontributions made, which he considered asanother indicator of the level of participationthat forms the foundation of the co-operativemovement.

According to Dr. José C. Guisado, IHCO President, the Seminar’s primarycontribution was the (bringing closer) ofmethodologies for collaboration between theprivate and public systems, while alwaysremembering that society is the ultimatebeneficiary and that the common objectiveshould be to offer service. Gabriela Sozanski,ACI director for Knowledge Management, spokealong these same lines, emphasizing theversatility of co-operatives in offering equallyvalid solutions in varying socio-economiccontexts and she recognized the willingness ofthe administrations in seeking a joint solutionto a problem that affects us all.

The final presentations were of aninstitutional character, evidence of theparticipation of representatives from thesesame administrations. Hence, AlejandroBarahona, General Subdirector of Promotionof the Social Economy in Spain pointed out thathealth systems are linked to their societies, andas a consequence, are also affected by socialchange. Thus, the most recent developmentspose questions about the viability of the publicsystem, a situation in which health co-operatives can play an important role. In thissense, it seems appropriate to advocate theirgreater involvement in the national healthsystem to adapt resources and needs, as wasrecently recommended by the European Union.Lastly, the Minister of Employment andIndustry in the Catalan Government, Josep M.Rañe, described social economy as the sectorof the future and as an efficient and democraticformula for combining collective interest,solidarity, participation and responsibility.Advanced societies require the participation ofits citizens in all arenas, especially those sectorsrelated to people. In fact, no business activitymakes sense if it does not have an impact onpeople’s quality of life. And herein lies theimportance that co-operatives have in offeringsolutions to health and social welfare problems,those very same ones in which theAdministration is asking for help. TheInternational Seminar on Healthcare and Co-operatives has been a magnificentdemonstration of this outlook.

ACI’s Director for

Knowledge Management,

Gabriela Sozanski.

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.


Dr. Francisco Ivorra,

President of Lavinia-ASISA.

ASISA Shares Its Experience

The president of ASISA, Dr. Francisco Ivorra,participated in a round table held during thesecond day of the Seminar analyzing the colla-boration of private entities in the HealthcareNational System. His presentation offered aview of ASISA’s experience.

Doctor Ivorra began by explaining ASISA’s cre-ation in the late sixties, as one of Dr. Espriu’sinitiatives to offer physicians from all theSpanish provinces a way of participating in anew formula for organizing healthcare acti-vity; one that would allow them to offer qua-lity healthcare assistance based on a directdoctor-patient relationship, as well as enjoygreater independence in the exercise of theirprofession.

The President of ASISA pointed out the factthat ASISA has been collaborating with thepublic healthcare system for more than 30years through the agreements with the threegovernmental mutual societies: MUFACE,MUJEJU (General Judicial Mutual Society), andISFAS (Armed Forces Social Institute). In addi-tion, ASISA co-operates with the PublicHealthcare System in numerous healthcareservice agreements.

The advantages they offer are well demons-trated by the fact that civil servants are theonly Spanish workers that can choose betwe-en public and private healthcare services(more than 85% choose private medicine). Thereason is that -- besides having a guaranteedand improved healthcare coverage with bene-fits officially approved by the HealthcarePublic System – they enjoy other advantagessuch as free choice of center and professional(both in primary assistance as well as specia-lized), no delays in access, and a single roomwith an additional bed for a companion.

The company’s chief executive explained thateven though ASISA is the main supplier ofhealthcare assistance for the three groups, ithas been able to grow without generating totaldependence on the public mutualism, due toits position as a company that owns a physi-cians’ co-operative. This has allowed the com-pany to reinvest its profits into improving

healthcare provisions and creating its ownhealthcare infrastructure. This has also allo-wed them to manage its own healthcare costsand offer high quality assistance to its asso-ciates despite inappropriate procedures forupdating premiums.

ASISA has also been able to generate a networkof healthcare centers that includes 15 of itsown hospitals and 1 participant, in ad thepolyclinics and the diagnosis centers andextra-hospitalary treatment that are immer-sed in an Integral Credentials Quality Plan ofall its units and services.

Traditionally, the centers focused on meetingthe needs of ASISA associates, but they arecurrently following a policy to gradually diver-sify its activity and becoming suppliers of spe-cialized attention for the healthcare servicesof the different autonomous regions.

During 2004, income from public sector agre-ements was about 10 million euros.Additionally, ASISA, Dr. Ivorra went on toexplain, co-operates with the Administrationin new management initiatives that arecurrently being promoted in the PublicHealthcare System.

The Torrevieja Project is one example of this.The Valencian Government has adjudicatedthe project – under administrative concession,which means public ownership but privatemanagement – to a temporary joint group ofcompanies (UTE) formed by a financial part-ner (Bancaixa and CAM), an expert (ASISA) anda construction partner. Thus, using this for-mula can generate mutual society services ata local level.

The project involves the construction of apublic hospital in Torrevieja (Alicante) and theintegral management of healthcare provisionin Area 20 of the Valencian Community. Theproject would be managed by ASISA as theexpert partner once the Hospital initiates itsactivity next year. This concession, contractedfor a specific period of time (from 15 to 20years), reverts back to the Administration oncethis period is over.

Elvira Palencia

health co-operatives conference, barcelona

Health & Medicine