Health co-operation is the solution for a sustainable national health systems – Silver Wave


Health co-operation is the solution for a sustainable national health systems

Carlos Zarco, the new Director General and Trustee of the Espriu Foundation, who takes over from Dr José Carlos Guisado as Chief Executive, will be combining his new responsibilities with those he currently performs as Medical Director of Moncloa University Hospital. In this interview he explains his aims and his views on the health cooperativism. How will you manage to juggle your work at the hospital and the Espriu Foundation? The workload at the Espriu Foundation, and also the International Health Co-operative Organisation (IHCO) and the International Co-operative Alliance (ICA) depended to a great extent on the positions that José Carlos Guisado held at those organisations, and the level of international representation that the Espriu Foundation had achieved. Of course, we aim to reinstate that position as soon as possible, but in the meantime neither the number of meetings nor the travel involved will be anything like those performed by Dr Guisado as President of the IHCO and Board Member of the ICA. What challenges have you set yourself as Managing Director of the Espriu Foundation? I had already for a year and a half been accompanying Dr Guisado on many of his international engagements. I was with him last year in Antalya, at the ICA Assembly, which was a real education for me. Not only the elections that resulted in the Presidency of Monique F. Leroux, but also because I realised what the Espriu Foundation represented on the international stage, and the extent to which Dr Guisado was recognised and in demand, with all the delegations asking him for advice. Although at the international level Dr Guisado set out a very clear path for us, the Vice-President of the IHCO is now Dr Eudes de Freitas Aquino, of Unimed of Brazil, who currently heads the organisation. The question now is what position the Espriu Foundation is left in. Whether we will stand for the Vice-Presidency or the Presidency, because one of the missions that the Board of Trustees has set itself is that the international efforts of José Carlos Guisado should be maintained, and that in the short term the Espriu Foundation should resume the pathway that he set out, and once again achieve this same level of representation. Meanwhile, one thing that the Foundation needs is a greater national presence. That is the aim I have set myself, because I feel that all the achievements that have been made internationally are very little known in this country itself. And not just that, but there are very few people who understand what the Espriu Foundation and its constituent institutions represent. People don’t know that Assistència Sanitària belongs to a cooperative of doctors, in the form of Lavínia, the owner of ASISA; that SCIAS is a users’ cooperative that owns a hospital… All of that is unknown, despite the fact that we are talking about large enterprises that generate thousands of jobs and serve millions of people, that have built 15 hospitals equipped with the latest technology, run by the very best professionals. We have done a really good job. Now we must give it the visibility it needs. I think that is the approach we should be taking. And so we are analysing ideas to see how we can give the Foundation and its constituent institutions the importance they really have, so that people can understand them. How did you first enter co-operative healthcare? I began to learn about what ASISA was when I came to work at this hospital, in the mid-1990s. But you could say that my doctorate in the cooperative movement came with José Carlos Guisado, who gave me the insight, together with Dr Ivorra and Dr Porres, into the co-operative health model of Dr Espriu, a unique phenomenon in this country and one which is very uncommon around the world, with doctors and users sharing management without any type of intermediary. One of the great paradoxes about cooperatives is that they are the most highly valued enterprise model in terms of public opinion, although people don’t understand how they operate. How would you explain that? People identify co-operatives with concepts that enjoy great social acceptance, such as co-operation and altruism. Of course, the co-operative movement benefits from this association of ideas, despite the fact that we then find that they only make the news when things go wrong, as in the case of Mondragón. What people don’t understand is that the fundamental difference with co-operatives, although of course they need to be sustainable and profitable enterprises, lies in the fact that all the profits are reinvested in our own infrastructure, which allows us to generate wealth, higher-quality care and better facilities, and better salaries for our doctors. And all that is possible because we don’t have to pay out dividends to any shareholder. That is what we need to publicise. In this regard, there are international initiatives, such as the ambitious study undertaken by the IHCO to determine the impact of co-operatives on the health of the general public… Yes, that is a study that the IHCO commissioned from EURICSE (European Research Institute on Cooperative and Social Enterprises). Regarding this issue, I once more recall Dr Guisado, who always said that if the organisations that make up the Espriu Foundation represent the third or fourth largest health co-operative in the world, that is the result not so much of the number of co-operative members, but the people they serve. Because if you are looking after three or four million people, then that is what really gives you an idea of the scale of the venture. ASISA has been working in partnership with the Spanish National Health System through the Muface mutual insurer for decades now. How do you think that partnership will operate in the future? ASISA has from the very outset been committed to its partnership with the National Health System, and the most recent figures indicate that 86% of civil servants opt for private insurers, of which there are now only two of us. As for the future, I believe that Health can only be complementary if we want it to be efficient and effective. It would be senseless to have overlapping resources. Why build a public hospital alongside a co-operative one, when you can also send your patients there? We need to show common sense and administer public funds as well as we possibly can, because resources are limited, above all with an ageing population. And within this context of ageing population and ever-increasing costs that are even threatening the sustainability of public systems, what role could health co-operatives play? I believe that the solution is to make national health systems sustainable. Anyone who believes the future has not yet arrived in certain aspects is making a mistake. It is already here. And a great many things will change: nanotechnology, genome-guided drugs… All of that will lengthen our life expectancy, but lead to much higher costs. And I do not mean just diagnostic equipment, but in daily health care: polypharmacy is hugely expensive beyond a certain age, even with affordable drugs, but when the drugs are more expensive it will be very difficult to maintain except through common sense and complementary action. Source:

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