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Administrative Mutualism: The Private Sector

In Spain there are five significant subsectors within the private health sector:

1. Private healthcare services contracted by the public. We are a group of hospitals and private clinics (finance and public procurement, private provision).

2. Private social enterprises with public funding. (public finance, procurement and private provision), consists of three components:

• The Administrative Mutualism, whose members have chosen the private provision;


• partner companies;


• The Workers' Compensation Mutual

3. The Health Concessions. public hospitals built with private investment under agreements that guarantee the investor the capitated financing with public funds, the comprehensive health care to the residents of a region for periods of 10 or more years and renewable.

4. Private Health Insurance , operating generally under the regime of double coverage. The public insurance is compulsory and universal (financing, purchasing and private provision)

5. Private Sub "pure." User pays out of pocket for health care it needs, without the intervention of any insurer, public or private (financing and private provision, private purchase individual). It is very difficult to quantify the economic volume of this activity, although considered very minor, due to the high cost of long-term treatment and surgery, so it tends to focus on specific private consultations, and in some cases, inexpensive surgical procedures in order to avoid long waiting lists in the public system or to receive health services not covered by the system of private health sector público.El future "pure" is secured by specific characteristics and the existence of groups population and types of medical activity in this sector has its share of the market that it could even be expanded both in private practice for certain medical specialties, such as hospitalization for some population groups.

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private healthcare services contracted by the system public.

Most concerted private provision is for hospital care, although there are other contracted services such as laboratories, radiology cabinets, etc, but much less weight. Over 30% of hospital beds are privately owned and its main public sector clients, private insurers, the Mutual of Accidents and Occupational Diseases, partner companies and users who pay directly servicio.Aunque no major private hospital networks, if there is agreement with certain insurers ( Asisa , Adeslas , Dkv ) and growing trend towards the association. Among the independent medical insurers are the Hospiten Group, Tenerife, and Dexeus Institute, which belongs to the American company Columbia Healthcare Corporation.

There is also a conspiracy to transport sick health care consists of ambulances, collective vehicles, ambulances care, all-terrain vehicles, hybrid vehicles, aircraft ambulance, Red Cross and 061 for medical emergency vehicle. The system of public sector concert with the private sector could become a future if it completes the introduction of an organized competition in the provision of health services, bringing the private sector can demonstrate its full potential.

Private insurance

Within private insurance sector can identify in a first level two submarkets: the sub-market of voluntary insurance and the submarket of staff public administration. The difference between the two markets lies in pricing, in the first, are the insurance companies who set the price, while in the second case is determined by the Administration.

With regard to voluntary insurance, anyone can apply, but due to universal public health system this means that 12.5% \u200b\u200bof the population has doubled (the largest public and private contract). Prices vary greatly depending on age and sex of the applicant, while not prohibitive, since the average cost of the premium for a man of 30 years starting from € 40 per month, while for women is a little higher, around € 50 a month and in some cases in addition to the monthly or yearly premiums to pay a fee per consultation.

Private insurance can be used either as a complement or alternative to public health (the latter is that of State officials), the advantage of private insurance is that companies have their own network of hospitals, clinics and laboratories , so that policyholders do not have to wait so long for treatment. It is important to note that many of these companies have waiting periods that can range from several months to 1 year before they can receive some services, especially in the for maternity and surgery, additional companies can insist that patients use only doctors who are members of their group. However, most have programs that refund 80% of the fees charged by physicians outside the group. Private insurance companies are the most important health Adeslas , Asisa , Sanitas , DVK and Mapfre Caja Salud .

7.05 million people now have insurance Healthcare, 0.8 billion of insurance in Reimbursement and 1.5 million in insurance compensation or allowances, that adding them together represent approximately 21% of the population with private health insurance. In previous accounts includes the majority of public servants clustered on Mutual Administrative , which are publicly funded choice between public and private system, this group has 2.5 million people representing almost 5% of the population and 85% choose the private option.

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Health Grants: public sector partnerships to manage the provision services.

Among the many figures that have been experimenting to ensure the provision of health services appears a novel: the "public works concession", a figure which allows a private company eligible for the construction and / or management of a public work for several decades, thus receiving public funds until the company in question and logically amortized cost, profit. For the health sector, public administration has prepared the land and a tender calling for firms interested in investing in the construction of a hospital, as consideration for this investment, the administration allows the contractor operating the hospital built for a term of 10 or 15 years extendable 10 or 15 years, assuring an annual capitation payment for each citizen residing in its area of \u200b\u200binfluence, at the end of this period, the Hospital should be given to public administration. This model guarantees free for the citizen and equity, control and funding by the Public Administration.

The first experience of this kind are recorded at the hospital in Alzira (Valencia), where the Valencia "gave" the management of a health area (the region of La Ribera, with 250,000 inhabitants) to a Temporary Business (Adeslas 51%, 45% Bancaja and CAM, ACS-Dragados Lubasa 2% and 2%), who built a hospital, with a final investment of € 72 million for its operation.

After the first experience with the Alzira Hospital, the Generalitat Valenciana other concessions began it, with the aim of bringing people medical centers that can be seen without moving more than 30 minutes from their place of origin.

These awards ensure the presence of the largest insurers in the Valencian Community Adeslas (Alcira), Asisa (Torrevieja and Elche), DKV (Denia) and Sanitas (Manises)
alliances These private insurers financial sector entities ( Bancaja and Caja de Ahorros Mediterranean-CAM) have been the key to success in boosting concessions. The

Madrid Health Service has already started a similar process to award the construction and management of hospitals, beginning with the Madrid Valdemoro which faith in November 2005 awarded the company Capio and is expected to become operational by mid 2007.

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