Report on the International Seminaron Healthcare and Co-operativesSergi 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 thisDr. 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 Healthparticipants 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 andAlfonso 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 theSNS of the Ministry of Laborand 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 198134 monograph | compartir |
legislative reforms that first established a not. This makes it necessary to “know how tohealthcare system of a public character albeit identify needs and how to address them inone with different provisions, in which “the order to avoid frustration on the part of bothprivate healthcare model began to assume a professionals and patients. The public modelcomplementary role. Let’s not forget that 24% needs the private when it comes to waitingof 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 offinancing model that relied more upon taxes MUFACE (the General Mutual Society of Statethan quotas. However, over the years, one of Civil Servants) described their unique modelthe 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 bycollapsing 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 choosethan an owner), or magnifying it (placing too services offered by either public or privatemany 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,” Románsystem users. Minister Geli pointed to the acknowledged, “a figure that demonstrates afollowing possibilities for doing this: good level of co-operation between the publicdecentralization 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, suchlinking it to concrete objectives, or the as establishing standards of good practices forimproving the drug offering, stepping up all service providers; educating the patientpharmaceutical 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 privateand public model can coexist and even practices; and their acting as a stimulating agentco-operate extensively. It all depends on of services offered.optimizing present resources. Professionals The next speaker was Boi Ruiz, the Directorand users must become involved in order to of the Unió Catalana d’Hospitals (the Catalanimpact the quality of the system and Union of Hospitals), who suggested that theguarantee its sustainability.”The Need for Public and PrivateCo-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 were Sub Director of the Catalan Health Service, Enric Agustí; Lavinia-ASISA’s delegate inthat 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 ofhis opinion, healthcare expenses will continue MUFACE, Carmen Román; Director of the Catalan Union of Hospitals, Boi Ruiz; and formerto grow even if the number of insured does SCIAS president, Lluís M. Rodà. JULY AUGUST SEPTEMBER 2005 35
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 goneDr. 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 UnitedMinister of Employment and exploring the various experiences of healthcare Health Organizations (Federación ArgentinaIndustry in the Catalan Government, co-operatives around the world, involving the de Entidades Solidarias de Salud). HisJosep M. Rañe, Josep M. Rañéand 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, whichSocial 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 health36 monograph | compartir |
spending from 700 to 253 dollars per person. was a difficult relationship between the publicHealthcare is one of the few public services that and private systems, as well as a competitivehad escaped the wave of privatization by the incursion by the pharmaceutical sector and aArgentinean government during the 1990s, due lack of preventative medicine. The solutionin 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, implicatingsome 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 waygrown 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 Josepappeared as a necessity and an alternative. M. Reygosa, the President of SCIAS, whoFAESS (the Argentinean Federation of Health emphasized that the State has gradually been Josep M. Reygosa, SCIAS Presidentand Welfare Establishments or Federación increasing its role in all arenas up to theArgentina de Establecimientos Sanitarios de point of disinvesting some of their privateSalud) was founded in 1999, its members initiative. Despite everything, in others, thisproceeding 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 weretheir respective professionals, from mutual the circumstances in which Autogestió-ASCsocieties and other entities in crisis. They and Lavinia-ASISA were created. Later, givencurrently 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 wasBorre, Director of Development for the Aylmer founded. Today, this co-operative includesHealth Co-operative, a project initiated in 2004 170,000 consuming members and more thanon 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 doeshospital center, owned by several doctors, was not yet have a legal structure: the Grouptransformed into a co-operative of doctors, Commission (Comissió de grup). Spain’susers and works to offer services to a healthcare sector is presently facingcommunity 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 theprimary care services. But this model began option of co-payment, despite its lack ofto slacken due to a reorganization of the popularity, appears to be the solution. Butpublic system in accordance to criteria of that’s not the point, because the State shouldcentralization and the low participation of place even more value on the role ofusers, which caused in Montreal alone the co-operatives, which are compatible with anyclosing 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 Associationof Healthcare Co-operatives, Dr. Hiroshi Ono; and Director of Development for the Aylmer Health Co-operative, Martinvan der Borre. JULY AUGUST SEPTEMBER 2005 37
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 CareThe Co-operative Experience of Autogestió-ASC shareholders are today’s co-operative partners. participative norms, with the final goal ofMelcior 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 areEspecially 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 healthcarehealthcare co-operatives around the world, was thanks to combined efforts with Societat Co- facilities needed to develop this socialDr. 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 hisone of the first organizations founded by Dr. created by the Dr. Espriu in the 70s, who had presentation, the figures available speakJosep Espriu, it became very clear that it is one just inaugurated the Barcelona Assistència. But eloquently. At present, Autogestió-ASC partnersof 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. ItAutogestió-ASC’s Consell Rector (Governing Foundation for promoting healthcare co- disposes of 20 offices in Barcelona, the servicesCouncil) and chief executive of the Foundation operativism throughout the whole world. of Barcelona Hospital and the emergency homeEspriu, began by explaining the project’s Today, other organizations like Biopat, CECOEL service provider SUD (Servei d’Urgenciesgenesis. In 1960, sponsored by the Barcelona and the Montepío doctor Luis Sans Solá form Domiciliàries) – both managed by SCIAS, andMedical 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 allocatesthe “igualatorio” model to establish the explain some of the elements shaping more than half of its income towardfoundations 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 theCol.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, thisEspriu’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 competitivewere his shareholders to constitute a co- premiums paid by the users, though also they market (62 entities) in a wide segment (21.28 ofoperative society that allowed them to self- participate – through a payment that is largely the population). In summary, as Dr. Martiorganize and be the protagonists of their own symbolic – with the voucher they present for reminded us, the 14% of all Catalans who relyprofession, advocating quality, personalized every visit. on Autogestió-ASC do so with a high degree ofmedical attention. Thus, Autogestió was born, The system’s mission is none other than to loyalty and satisfaction, a trait they share with38 doctors’ co-operative society that since thenthe involve medical professional and users in thehas governed the direction of ASC. Its the same physicians who offer their services as same system, governed by democratic and partners.
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 to the oncology and magnetic resonance units,the increase in the healthcare bill. Their and later, the computer systems. The secondprocess, driven by the opposition from the stage, which is currently underway, involves thephysicians, forced the Government to make construction of public hospitals by privatesure 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 thean organization such as the National Co- Administration, which pays according to theoperatives Policy. Currently, the healthcare number of assigned healthcare targets, issector 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 foroperatives that service specific communities. structuring the system. There are only twoTheir model is based on guidelines established exceptions: healthcare prostheses and primaryby Dr. Espriu for mixed co-operatives of care pharmaceutical spending.professionals and users, something that Dr. Miquel Vilardell, Professor of Medicinefacilitates more extensive and the best possible at the Universitat Autónoma de Barcelona andquality of service. In its own right, the Doctor’s Department Head of Internal Medicine at theCo-operative of Malaysia was one of the Vall d’Hebron Hospital was the last speaker. Hispioneers, founded in 1957 in the urban area presentation shared some of the indicators thatof Media, and later expanding to the country’s can be used for comparing the private andrural 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 offor Autogestió-ASC’s Consell Rector (governing structures, motivation, incentives, and ongoingcouncil), who analyzed the development and training for professionals, and user satisfaction.circumstances of one of the entities He used these same measures in his recentchampioned by Dr. Josep Espriu. report on health in Catalonia, an experienceCreative 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 health Geraint Day, representative from Co-operatives UK and member of the Executive Committeesector 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 Presidentwas 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
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 andACI’s Director forKnowledge Management, the administrations in seeking a joint solution Co-operatives has been a magnificentGabriela Sozanski. to a problem that affects us all. demonstration of this outlook.40 monograph | compartir |
ASISA Shares Its ExperienceElvira PalenciaThe president of ASISA, Dr. Francisco Ivorra, healthcare provisions and creating its ownparticipated 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 costsboration 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 networkation in the late sixties, as one of Dr. Espriu’s of healthcare centers that includes 15 of itsinitiatives to offer physicians from all the own hospitals and 1 participant, in ad theSpanish provinces a way of participating in a polyclinics and the diagnosis centers andnew 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 oflity healthcare assistance based on a direct all its units and services.doctor-patient relationship, as well as enjoygreater independence in the exercise of their Traditionally, the centers focused on meetingprofession. 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 servicespublic healthcare system for more than 30 of the different autonomous regions.years through the agreements with the threegovernmental 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 totion, ASISA co-operates with the Public explain, co-operates with the AdministrationHealthcare System in numerous healthcare in new management initiatives that areservice 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 adjudicateden public and private healthcare services the project – under administrative concession,(more than 85% choose private medicine). The which means public ownership but privatereason is that -- besides having a guaranteed management – to a temporary joint group ofand 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) andPublic 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 roomwith an additional bed for a companion. The project involves the construction of a public hospital in Torrevieja (Alicante) and theThe company’s chief executive explained that integral management of healthcare provisioneven though ASISA is the main supplier of in Area 20 of the Valencian Community. Thehealthcare assistance for the three groups, it project would be managed by ASISA as thehas been able to grow without generating total expert partner once the Hospital initiates itsdependence on the public mutualism, due to activity next year. This concession, contractedits position as a company that owns a physi- for a specific period of time (from 15 to 20cians’ co-operative. This has allowed the com- years), reverts back to the Administration oncepany to reinvest its profits into improving this period is over. JULY AUGUST SEPTEMBER 2005 41