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RL: RL Coopesain

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Costa Rica: Coopesana

After successful experiences with the creation of Cooperatives Health and Tibas Pavas (COOPESALUD Coopesaín in 1988 and 1990), the Social Security Fund (CCSS) promoted a new cooperative in the canton of Santa Ana, 15 miles west of San José Canton, to tend the local people, who by then were 27,000 people, through an agreement that allows the cooperative to manage the clinic since the CCSS and 10 Ebais that provided that area of \u200b\u200bhealth. Unlike its predecessors, this cooperative is jointly owned between users and workers centers.

Health Cooperative under the model of co-management between users and suppliers.

Health Cooperative "Coopesana" began operations in May 1993 being the only health cooperative that uses the co-management model, this model allows for participation as partners and owners to workers related to the cooperative and the community receiving services represented last for 12 organizations, including the Lions Club, sports associations, pensioners, local government, among others, has the advantage over using the other health unions, where there is greater citizen participation, community members appointed to the organs directors of the cooperative and are closely managing their own health services (Health Cooperative of first-degree property shared by users and providers).

Expands initially agreed area of \u200b\u200bfocus.

late 1997 and as part of sectoral reform, the CCSS introduced subscription of "management contracts" as a new mechanism for allocating financial resources to hospitals and health areas, which meant the extension of the agreement initially signed in 1993, since January 2002, the CCSS approved an addendum to extend Coopesana allowed health services across 7 new Ebais, the areas of San Francisco de Dos Rios San Antonio's Homeless and thus currently serves the medical needs of 73,848 inhabitants in all assigned areas offering services in general medicine, pediatrics, gynecology, outpatient surgery, dentistry, nutrition, social work, psychology and emergencies, these contracts were extended in May 2004 and then in December 2006, the latter for two years. Unlike other established health cooperatives in Costa Rica, Coopesana has received equipment and pay rent for the use of the facilities provided by the CCSS, which is offset by a payment per person slightly higher than that received by other cooperatives. Between 1,999 and 2,006 have received payments amounting to ¢ 8.066 million (U.S. $ 15.5 approx.)

outstanding accomplishments.

Among the most significant achievements of this cooperative is the increased coverage to policyholders because they began in 1993 covered 73% of the population assigned, and in 2002 reached 95% of that population also pioneered the use of electronic record, an initiative followed by the other unions in health and subsequently by other health agencies in the country . In February 2005, opened a new Ebais Coopesana equipped to provide services in general medicine, gynecology, dentistry, pediatrics and laboratory, among others, provides services to 3,600 uninsured in the community of San Rafael de Santa Ana, the center's construction was funded completely by the cooperative in an investment of ¢ 60 million (U.S. $ 115,400) and is built in an area of \u200b\u200b305 meters painting donated in 1994 by the City of Santa Ana

Linkage partners.

workers to acquire the status of partners that work requires a minimum of three years so they can apply to join the association and must provide ¢ 26,500 (U.S. $ 51 approx.), And capitalize the annual surpluses he may have, which are removed by the resignation or dismissal of 125 employees only 63 are associated, which is explained by an increase in staff was to meet a new front in San Francisco working for less than 3 years . People who are not workers health can only be members through partnerships.

Integration with other health cooperatives.

It is part of RL Consalud cooperative consortium, along with three other existing health cooperatives in Costa Rica (COOPESALUD RL, Coopesain Coopesiba RL and RL), more Coopemex, Coopeagri And Coopesanta, that also handle health projects for social projection. Through this cooperative partnership, Coopesana initially participated in the cooperative hospital project in San Carlos, but then withdrew.

Information Additional Information:

To complement and understand the role of RL Coopesana in the Health System of Costa Rica, please consult the following links:

• Health Cooperative in Costa Rica.
• Summary of Current Health System (II).
  

Technorati tags: coopesana , "CCSS" , "health cooperatives" , "EBAIS" , "Costa Rica"

Blogalaxia Tags: Blogalaxia coopesana Cooperatives + of + health EBAIS cooperatives Costa + Rica Consalud

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RL Costa Rica: COOPESALUD RL

is the first health cooperative created and integrated as a provider of social insurance system in Costa Rica, with this entity opening the way for the development of the cooperative model as an alternative for health care areas in a decentralized manner with emphasis on primary care. We present an account of the process which resulted in her pregnancy and later development:

Background.

adjustments initiated in the 80s in Costa Rica, proposed the redefinition of the social role of the state and created the conditions to promote and propose new ways of managing health services traditionally provided by the State. At that time, a group of experts on the subject conducted a series of seminars and forums to address issues that had the medical services of the Social Security outpatient looking to give a concrete answer to the serious problems of access to health services especially at the level of outpatient clinics and hospitals, finding little support among academics, entrepreneurs and workers organized in unions. This led to the Social Security Fund (CCSS) pilots agreed to implement plans to develop ways to provide alternatives to existing ambulatory care model, where the very CCSS is the funding body, acting as the sole purchaser and provider of medical services, as they were known then [1] , context in which it was born COOPESALUD RL, the first health cooperative in the second half of the eighties.

Costa Rica were already important precedents for the reorganization of primary care. One was the call "Hospital Without Walls" in San Ramon , originally a thriving coffee region, 60 km from San José. It was a program of health care outside hospital walls, which achieved significant accomplishments in improving health conditions but at a very high cost, and diversion of resources toward primary care hospital. From that experience was introduced later in a semirural town experience that health services were offered to the community by an association called Acepromazine , consisting of doctors to attend a Barva area, village north of the Central Valley, the Social Security Fund (CCSS) paid to the association of medical services per capita, and the association paid doctors in terms of services provided to patients. The CCSS and Ministry of Health gave the local team and put the rest of the staff, this model faced a number of management challenges for its experimental nature, not by the quality of service and the problems of management: staff CCSS , the Ministry of Health and doctors of the association had different schedules and institutional cultures that failed to harmonize. Despite the failure of the pilot, the experience gained in Barva de Heredia was the basis for the CCSS introduced the Cooperative for the provision of health services and this is how in the year of 1988 promoted the creation Cooperative COOPESALUD the RL. to administer the new Pavas Clinic and served under this mode of payment and the family medicine approach Pavas community, and somewhat paradoxically, the last place where it has consolidated Model Health Cooperative is precisely in Barva de Heredia, which hosted the pilot project.

It is
Cooperative
The decision to form a cooperative was communicated to the workers who worked in the area and this is how Thirty-four (34) forty (40 ) members of the CCSS they were providing services in the area left their jobs and were the "self-managed cooperatives Comprehensive Health Services - COOPESALUD" on 8 October 1987, it is a company cooperative self-management (the equivalent of a Labour Cooperative Association), nonprofit, regulated by the Law of Cooperative Associations in General and in Particular Statutes.

Implementation of the first cooperative health

The introduction of the District Cooperative Pavas, the Canton of San José, was a clear response to cyclical the serious problems of access and equity that was living at the time, however, to make possible this experience, is required to comply with the essential requirements of change.

• First, was necessary to develop an extensive outreach program and comprehensive explanation on the scope of the project, the neighbors organized in marginal urban community Pavas where be carried out the project (a district of the Capital), and the politicians and leaders of the health sector and the Legislature.
• Secondly, it promoted an extensive review of existing legal framework that would accommodate the pilot, which was possible thanks to the tenacity and high clarity of the project leaders, and
• Thirdly, the political decision of the government (administration of President Oscar Arias Sanchez) to urgently seek ways to improve the delivery of health services.
  

COOPESALUD RL , under the agreement with the Ministry of Health and the CCSS , took responsibility from August 1988 to the attention of the district clinic Pavas (which is part of San José Canton and is located at the southern end of this canton, capital of the province San Jose), which at that time had a population of 30,000 (although for the year 2001, according to national census, had 77,469 inhabitants, due to rapid urbanization and insecurity in the area). Under this arrangement the cooperative managed assets (Department of Health with their respective envelope) and services while maintaining state-owned property assets, can use the facilities that are CCSS, Maintenance, Repair and acquisition of new equipment, pay utilities and officials. The community wanted COOPESALUD RL assume all services health, but this was impossible because of the cost of infrastructure and equipment of hospital care. After the Reformation, the mode of recruitment began expanding the concept to be generalized, since the clinics will not only cover an area of \u200b\u200bmajor influence, but also were responsible for the administration of Ebais. Thus, by the late nineties, the clinics began to take on areas of health and administration.

Operating the

Although the service is privatized, this did not mean any change to the user who continue trading at the CCSS , and a Cooperative Agreement between the and CCSS defines the services to be provided, standards and controls to be observed, the User fees pay for on a capitated by the CCSS (recruitment scheme has a geographical basis and is based on a rate per capita falls within the health area served), and not by activity paid with funds from of the CCSS ; users do not pay for the services they receive at the Cooperative.

Capitation payment to the Cooperative, innovator and pioneer in Latin America, helping to maintain a balance between economic interest of the Cooperative and the social objectives that must provide the public health insurance. Initially rejected by the institutions, this payment system was taken as a reference for deployment to the country-wide under the reform process after the health system. Currently, the per capita payment is negotiated annually on a bilateral basis, and the assigned population amounts to 179,969 residents who are seen in 26 Ebais of Pavas districts and Homeless in San José Canton.

In the area of \u200b\u200bhuman resources should be noted that RL had COOPESALUD to October 2006 with 360 staff of whom 330 were members and the rest temporary. By law, cooperatives are not allowed to impose "stringent conditions" on admission of new partners, "should be encouraged" even officials not associated with a contribution can do ¢ 125,000 two-year term (approx. U.S. $ 240 .) Wages of workers is higher between 5 and 15 percent than those paid in state health institutions.

COOPESALUD Other business.

Trying to reduce its dependence on CCSS and generate resources from other sources (sometimes surplus ¢ only reach 7 million), COOPESALUD RL. Company created the "Servisalud" offering private medical services in downtown San Jose and sell drugs in Homeless. 11% of its workers are depending on this company. Separate accounts are maintained on the contract you have with the CCSS , which is not touched a weight and officers of the CSSS are aware of private operations.

also involved through the consortium Consalud in control of the Cooperative Hospital operating in the city of San Carlos Quesada of the Canton of the province of Alajuela.

[1] Many years later, he started talking about health care and more recently, as health services are developed, comprehensive health services.

To complement and understand the role of RL COOPESALUD in the Health System of Costa Rica, please consult the following links:

• Health Cooperative in Costa Rica.
• Summary of Current Health System (II).
  

Technorati tags: COOPESALUD , "CCSS" , "health cooperatives" , "EBAIS" , "Costa Rica" , Pavas

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cooperative relationship with the Security Fund Social (CCSS) began in 1988 with the involvement of the first cooperative, after the CCSS regulated an article by its constitutive law to do "projects" with public or private entities wishing to contribute to health, setting up a model new and alternative care to the existing. However, between 1988 and 1997, cooperatives were growing, albeit without addressing where the authorities wanted to get the CCSS , as this was within a reform process, precisely to pre-reform most the budget of the CCSS be turned according to who demanded more money, not based on technical criteria. From this experience emerged innovative ideas, such as Ebais .

In late 1997, began the signing of management agreements, in which the CCSS called to their clinics and hospitals as internal drives and external drives cooperatives as . It starts a negotiation process that enters into a determined and allocated a sum of money. A cooperative communities are set according to population, are paid an amount of money per person (per capita), assuming the risk that they will be few people to be sick, although they are paying for all, why struggle to keep all the healthy through prevention programs.

In November 2006, the CCSS been extended three times each of the contracts signed in late 1997 with cooperatives Coopesaín, COOPESALUD, and Coopesana Coopesiba to continue by the services they provide clinics and Ebais of Tibás , Pavas , Barva and Santa Ana respectively. A cooperative is paid per month, however it Guarantee Reserve maintained, which is canceled once the box checked that all services for which you are paying is actually offered to patients. This model was extended to 2 non-cooperative, the University of Costa Rica (UCR) and ASEMECO Association, the four cooperatives Along with UCR and ASEMECO , attend 15% of the population of the country and the CCSS attends directly to the rest.

How the cooperative model of health.

The first to be created COOPESALUD was in 1987 in response to the need for a change in the health care model of the Social Security Fund to new needs in the country. Incorporated cooperative promotion and prevention to treatment and rehabilitation. These principles gave rise to the first team Basic Comprehensive Health Care (EBAIS), born in COOPESALUD , Pavas.

there are four co-operatives that sell services to the Fund: COOPESALUD (clinics and 26 in Pavas Ebais and some sites Homeless ) Coopesana (Clinics and 17 Ebais in Santa Ana , San Francisco de Dos Ríos and San Antonio), Coopesaín (clinics and 25 in Tibás Ebais , Paso Ancho and San Sebastian ) and Coopesiba (Clinics and 13 Ebais Barva de Heredia and San Pablo de Heredia ). These four cooperatives tended to November 2006 to 413,052 residents and employing approximately 812 workers

What is your operating system?

COOPESALUD, Coopesain Coopesiba and self-managed cooperatives are , meaning that only allows the association of workers (the equivalent of a Labour Cooperative Association). In Santa Ana , the cooperative Coopesana is the only one that uses the model of co in participating as partners and owners of workers related to the cooperative and the community receiving services, represented the last of 12 organizations like the Lions Club, sports associations, pensioners, local government, among others, the latter model has the advantage is that there is greater citizen participation, community members appointed to the governing bodies of the cooperative and are closely managing their own.

The Social Security Fund (CCSS) is responsible for health services, but for the provision of these private providers can use the facilities that are CCSS, Maintenance, Repair and acquisition of new equipment, pay utilities and officials. The objectives of these providers of social sector and solidarity, as any company is to generate profit but profit, which manage to remain competitive and providing good service.

What is its structure?

Each has General Assembly, which is its highest body. There is a board, an oversight committee (for funds) and one of education and welfare. Currently, the four cooperatives integrated a consortium called Consalud to explore new markets, the consortium acquired in December 2003, the Private Hospital Mount Sinai, which traversed a major financial crisis, located in the district of Quesada (San Carlos Canton ) and reopened as a Cooperative Hospital, the first private hospital of its kind in Central America.

How are they financed?

Nearly all its revenue from the sale of services to the CCSS . The value of these contracts was in 2005 more than ¢ 8,300 million annually (U.S. $ 15.9 million approx.), Equivalent to almost 20% of the medical services CCSS in that year. It is estimated that in 2006 the expenditure amounted to ¢ 10,000 million annually (U.S. $ 19.3 million approx.). The surpluses are around 2 to 2.5 percent per year and is reinvested in equipment and facilities. Looking for alternative income COOPESALUD created the company Servisalud , society anonymous giving private medical services in downtown San Jose and sell drugs in the Canton (city) Homeless.

What services do you offer?

These cooperatives began providing basic services, but the CCSS they were moving more features and now offer everything from outpatient and prevention services such as vaccination and control of pregnant women, to specialties such as dentistry, psychology and others. Some also make prevention campaigns, schools, parents, home visits, offer longer opening hours flexible and are moving to electronic record system.

How do you get an associate?

By law, cooperatives are not allowed to impose "stringent conditions" on admission of new partners, "should be encouraged," because the idea of \u200b\u200bno profit to distribute the profits among its members and not in the hands of a small group. In November 2006, reported the following:

• The self-managed cooperatives (Working Partner): Coopesiba In to join must be working for several months, take courses and make the request to the assembly, which meets once a year, demonstrating that not all send the request, of 134 employees only 52 are associated. In COOPESALUD, 330 of the 360 \u200b\u200bemployees are partners and others are temporary, and who wish to join, you must make a contribution of ¢ 125,000 (U.S. $ 240 approx.) For which there is a term of up to two years term to cancel. In Coopesaín , 122, 193 workers are partners, not have more data.
• In Coopesana, Cooperative co-managerial , it requires workers to work a minimum of three years so they can apply to join the association and must provide ¢ 26,500 (U.S. $ 51 approx.), And capitalize on the respective annual surpluses, which are removed with the resignation or dismissal of 125 employees only 63 are associated, which is explained by an increase in staff was to meet a new labor front in San Francisco less than 3 years.

What is your personal policy?

function as a private company. In November 2006, cooperatives were over 800 workers, most associated. The base salary is similar to the CCSS , but the cooperatives do not recognize the old. If an officer does not work, is cut off from their jobs and lose their membership.

The effectiveness of Cooperative Health exceeds that of the centers belonging to the CCSS ...

health cooperatives, compared with their own units of the CCSS , provide greater timeliness and coverage services to the population in their areas of responsibility: for example, 80% of patients attending a health cooperative contract with the Fund are treated by the doctor in less half an hour, which happens only in 40% of metropolitan clinics operating under the traditional system, in terms of coverage, for the year 2,002 cooperatives managed coverage for children under one year of 74% compared to 61 % of units own CCSS.

In recent years, the centers run by cooperatives have become the first with all computerized processes. The cooperative model in its outcome has been positive for the provision of health services, especially in promoting healthy habits and prevention of disease by the impact of these healthcare services for populations they serve and the response have given policyholders.

... But there are legal and efficiency issues that threaten the continuity of the model.

Although the CCSS argued that this system was cheaper and of better quality than the services, according to reports from the Audit CCSS and the Comptroller General of the Republic in October 2006, private services offered by cooperatives come together more expensive than those provided directly by the CCSS model or the University of Costa Rica , serving in their own infrastructure and do not receive any benefit, while the CCSS buildings and equipment lends free three cooperatives, incentives paid and adjustments have been made millionaires and discounts not provided in the contracts.

Given the above, an extension was expected to be 5 years from 2006, only authorized for two years as opinion of the Comptroller General of the Republic this is the time required for CCSS that bid, assume the services or encourage the creation of a new system of private participation.

Lobbying.

benefits discussed today demonstrates the great power they had acquired the Cooperatives, and extend it managed to sign contracts directly in spite of government contracting rules in Costa Rica provides that the allocation of these should done through public tender.
In the new scenario that threatens the continuity, or at least the almost exclusive health contracts awarded by the state to private entities, health unions are pushing a bill that would give privileges to contract with the Fund Social Security (CCSS), which are based nonprofit organizations, although the surplus are distributed among the partners. These entities have been lobbying to "encourage direct procurement" or some mechanism to keep their contracts.

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Costa Rica Costa Rica: Summary of Current Health System (II)

Health Services Delivery

Public Health Services

The Ministry of Health of Costa Rica (MS) has virtually transferred all population-based programs to Social Security Fund (CCSS ) but still dictating policy guidelines for promoting health care policies to emphasize the promotion and chronic disease prevention. Moreover, given the epidemiological profile continues conducting programs to prevent infectious diseases such as diarrhea and cholera, acute respiratory infections and pulmonary tuberculosis. The MS is in charge of the prevention and control of dengue and malaria, as well as maintenance of the elimination of canine rabies. In terms of specific protection, vaccination remains a priority program.

health care services individual

To ensure the services to which they are entitled its affiliates, the CCSS as the only officially recognized public provider to cover maternity insurance and has arranged network care into three levels according to the technological complexity of the resources they use, their different response capacity and portfolio of services offered, related by mechanisms of reference and referral of patients.

The first level of care

Services include health promotion, prevention, cure of illness and rehabilitation of lower complexity in the field house, community, school and the outpatient health facilities and provides access to upper levels of the system services are bundled into two categories: 1) comprehensive care programs including prevention and promotion and 2) care of the demand for prevalent disease. These services are provided through emergency departments and clinics, 812 hospitals and Basic Teams for Integral Health or EBAIS, one for each health sector that subdivide the 94 health areas, grouped in turn the 7 health regions established for the country. A EBAIS is formed by a physician, a nurse's aide and a Technical Assistant or Primary Health Care and several EBAIS ATAPS are advised by a support team consisting of: doctor (a) of family, nurse (o), worker (A) social, dentist (a), nutritionist, pharmacist (a), a microbiologist (a) and technical (a) medical records, each EBAIS serves between 2.500 to 7.000 inhabitants (depending on the degree of dispersion of the population) with which the total population covered with first class services was 3,547,401 inhabitants in 2002 (90% of the population);

Notably to expand the coverage of the first level in areas lacking infrastructure, CCSS began in 1988, a pilot experiment buying services to a health cooperative ; this experience favorable results in terms of quality and cost, which gradually expanded and by 2004 it had agreements with four health cooperatives , the University of Costa Rica and Rican Medical Services Association ( ASEMECO) Clinica Biblica through which they cared about 500.000 inhabitants. Heredia metropolitan area, representing 15% of the national population. In addition to the cooperative strategy to improve access and service coverage the CCSS initiated two additional strategies: the mixed medicine, in which the insured selects and pays for private medical consultation with a registered CCSS and the institution conducts studies and provides the medication prescribed by a private practitioner, and the company doctor , where it hires a doctor to assist their workers in the workplace and the CCSS gives diagnostic services and medicines.

hospitalization, surgery and specialist consultation

At the second level consulting services are offered specialized hospitalization and medical and surgical treatment of the basic specialties of internal medicine, pediatrics, obstetrics and gynecology and surgery in a national network of 10 health centers, 13 peripheral hospitals and 7 regional hospitals.

The third level provides specialized care and complex medical and surgical treatments, through 3 national hospitals general (Mexico, San Juan de Dios and Dr. Rafael Angel Calderon Guardia) and 5 national specialized hospitals ( women, children, geriatrics, psychiatry and rehabilitation). Due to insufficient investment hospital infrastructure in the decade of the eighties and nineties and population growth, the buying public offering expanded services to hospitals and private companies.

management commitments

since 1997 and as part of sectoral reform, set out the management commitment as a new mechanism for allocating financial resources to hospitals and health areas, which are signed annually for those providers with a Central Management Services purchase CCSS and which sets targets negotiated with concrete results.

Subsector private

As for private health services than those who participate in the program to expand coverage, it should be noted that this subsector is constantly expanding and has a network of different degrees of complexity, from simple to large hospitals and clinics on the other hand, household surveys reveal that 30% of the population uses at least once a year. Among the conditions that have encouraged this expansion can include the following: the increasing direct demand for these services by users from different backgrounds, the purchase of services private and public institutions as CCSS and INS and insufficient supply of some services by the public health sector. Moreover, the emergence in the market for private insurance companies services in the form of prepaid medicine, has stimulated private investment in the health subsector and its growing expansion can be estimated indirectly by the number of professionals in the works, which increased from 9.9% at the beginning of the nineties to 24% at the end of the decade. This subsector has two sources of funding, direct payment users and less important as the payment it receives from government agencies such as the INS and the CCSS who buy services to meet the occupational disease and general condition of its affiliates, respectively.

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Costa Rica: Summary of Current Health System (I)

Organization

general
The public health services consists of:

- The Ministry of Health (MOH) , making the steering and monitoring sector, and promotes programs promotion and health prevention.

- The National Health Sector Council (CNSS), instance of agreement across the sector whereby action is taken to address problems and public health issues of national interest.

- The Social Security Fund (CCSS) , that is charged with ensuring of health that includes comprehensive medical care to people, cash benefits and social benefits;

- The Rican Institute of Aqueducts and Sewers (AyA) , which is responsible for providing and regulating the provision of drinking water and sewage disposal;

- The National Insurance Institute (INS) , that covers all risks and accidents and traffic;

- The University of Costa Rica : that is responsible for training health professionals in pre and posgrago in the country, and

- Municipal governments. MS

The part of the executive branch and in conjunction with the CNSS, is responsible for coordinating the sector. While CCSS, INS and AyA are decentralized and semiautonomous agencies, with law and its own, each directed by a Board and CEO.

The Assurance

The public health insurance.

By constitutional mandate and in accordance with Universal Law Health Insurance of 1961, the CCSS must provide health insurance and maternity benefits to all people, but since this is only compulsory for wage earners, from 1975, other forms developed to facilitate the incorporation of other segments Population:

- Voluntary insurance for self-employed persons created in 1975;
- The CCSS pensioners and special arrangements were incorporated in 1976;
- Insurance from the State to include the poorest families in 1984;
- Special Agreements collectively to ensure the combined independent workers union organizations in the mid-80's

Despite this, the 2000 population census revealed that only 81.8% of the population is insured, so that 18.2% of the population lacks formal health insurance. Although the uninsured can use public health services, in practice, this involves overcoming barriers of administrative and economic limits their access to these services.

required under their health insurance is financed on a tripartite basis according to the following amounts: 9.25% employers, workers, 5.50% and 0.25% State, for a total of 15%. In the other types of insurance contribution rates are much lower than 15% as employees and their employers are heavily subsidizing the other categories, which is consistent with the principle of solidarity, in all cases the insurance extends to the basic family unit.

Coverage of general insurance and maternity

public health insurance covers sickness and maternity benefits to all its population insured through 5 programs (as defined in the mid- nineties, in the context of health sector reform and the analysis of the national health situation which identified 12 priority needs) for children, adolescents, women, adults and older adults also include actions to promote protection and assistance activities to ensure the provision of basic and specialized medical services, both outpatient and hospital laboratories, provision of drugs and basic dental care through a network of establishments and contractors.

The supplementary insurance

cover the risks to the Traffic Accident and Occupational Disease State developed a complementary insurance system administered by the INS , with an additional cost citizens and whose coverage is limited by what spending peaked established, attention shifts responsibility to the CCSS . To ensure these coverages the INS has its own care but reduced response capacity, so you must buy services from private companies.

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Costa Rica: General Information, territorial organization and data

COSTA RICA (2006)

following information is presented in order to understand the context in which they operate Health Cooperatives in Costa Rica.

name: Republic of Costa Rica
Form of Government: Democratic Republic
Constitution: Promulgated the November 7, 1949
Area: 51,100 km ² .
Capital: San Jose
Currency: Costa Rican Colon (¢, CRC)
GDP (2005): total U.S. $ 44,579 million, per capita U.S. $ 10,316
Language: English.
Administrative divisions: 7 provinces subdivided into 81 cantons, and these, in turn, into 463 districts.
National holiday: September 15, Independence Day
Population: 4,016,173 inhabitants. (Referring to 2005)
The population density is 75 inhabitants per km ². About 52.3% of the population is urban.
Ethnic composition: white (80%), mestizos and mulattos (15%), blacks (4%) and Asian (1%)

Territorial Organization

Costa Rica is a Central American country. Bordered on the north by Nicaragua, southeast by Panama, the land is bathed in the east by the Caribbean Sea and west by the Pacific Ocean. It is divided into seven provinces: San José (7) is the province with the largest population (1,345,750 inhabitants) and its capital, the same name and also capital of the Republic, residing 340,562 inhabitants in 2005, the other 6 provinces are Alajuela (1) with 716,286 inhabitants, Carthage (2) with 432,395 inhabitants, Guanacaste (3) with 264,238 inhabitants, Heredia (4) with 354,732 inhabitants, Lemon (5) con389.295 room and Puntarenas (6) with 357,483 inhabitants, also has a large overseas territory close to 500,000 km ², which includes Isla del Coco, located about 480 km southwest of the Osa Peninsula on the Pacific coast. Those provinces to are further divided into cantons (81 in total) and the latter in turn into districts (459 total).

The country is known for keeping one of the most established and transparent democracies of America, for having one of the best indicators of human development in the region and for being the first nation to abolish the army in 1948. The political system is centralized administrative and fiscal and budgetary allocation to the various sectors is determined centrally so inflexible.

Costa Rica has suffered a significant evolution in its economy, from being a predominantly agricultural country to a service economy. Tourism is the industry that has contributed more positively to GDP. Leveraging its peaceful environment, high educational level of its inhabitants and appropriate policies to attract businesses, the country began in the mid 90's in the production of materials and micro technology products and technology (since 1997, with the input Intel chip factory, the country has had an additional source of income) and is preferred by many multinationals to locate their core services within the region, highlighting Coca-Cola, Procter & Gamble and Dole. Export earnings coming from traditional agricultural products such as bananas, coffee, sugar, cocoa and pineapple are still important (also grows corn, beans, vegetables, snuff and cotton). Manufacturing and processing is represented in food processing, textiles, chemicals and plastic products as the most important. The livestock consists of cattle, pigs and horses, and poultry, meat being an important export. Although there are some mineral deposits (mainly gold) and has established the presence of oil reserves in the territorial waters of Costa Rica, the country has started its operation since the debate between maintaining its status as a country protects the environment and the extraction of these natural resources .

has a GDP of about U.S. $ 44,579 million for 2005, representing per capita U.S. $ 10,316 (the highest in Central America. The annual inflation in 2005 was approximately 13.2%, one of the highest in recent history and the highest in the continent. Unemployment is around 6%.'s biggest weakness Costa Rica's economy is its heavy dependence on oil imports, mainly from Venezuela and Mexico.

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Health Cooperative population in Spain: Josep

In the previous post the first cycle is completed on Health Cooperatives in Spain, this first exercise deals with the context in which they now carry on this type of cooperative, providing relevant data on the Kingdom of Spain, their general and specific to the public and private health sector. It's very interesting to stop and analyze how a system of universal health coverage and free, with good acceptance by the public, open space and starts to grow the private insurance sector, in which cooperative societies physicians have a management model based not on profit and free choice by the user of the health service provider.

describes the Integral Health Cooperative, developed in a different man for his thoughts, ideals, leadership and implementation capacity, Dr. Josep Espriu Castelló, the value of a being of these qualities is immeasurable, and whom we admire his work was considered a beacon showing us the way forward to address the practice of medicine in competition model allowing the coexistence of commercial companies that profit, often to the detriment the health service provider (doctor, health workers) and / or user. Perhaps there are other good people and I want the readers of this blog to collaborate and gave its life and work, some very respected men have materialized health cooperatives important but should be investigated if they are able to share and disseminate its key success and / or whether the economic outcomes are reflected in the improvement of the most important medical procedure: the user and the doctor or health worker. Dr. Josep Espriu also conceived within its visionary model a consumer cooperative SCIAS, owner of the Hospital of Barcelona, \u200b\u200bwhose story and achievements will expand when addressing the issue of Health Co-owned by users and / or consumers.

On the other hand, S. Clinical experience Coop shows us another idealist, who is stripped of a profitable company and gives it to those who have achieved the goals I had when I created it: their employees. These workers, far from being intimidated with a tremendous challenge, showed that the desire, training and the joint commitment may make it possible to advance a cooperative health workers in a very competitive environment.

In summary, we presented the following issues, which can be accessed through the following links by clicking on them:

• Spain: General information, territorial organization and population data
• Spain: Summary of Current Health System
• Spain : The private sector in the English health
• Spain: Administrative Mutualism
• Health Cooperative Development in Spain
• Espriu Castelló Joseph: Founder of Integral Health Cooperative Clinical
• S. Coop. Ltd - CES S. COOP: English workers make the company where they worked in a successful Health Cooperative

The texts of the different post with links that give access to sources of information and some downloadable documents include those interested in more information on the content of each of these.

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