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.
Blogalaxia Tags: Blogalaxia coopesiba cooperatives + in + health EBAIS cooperatives Costa + Rica Consalud Coopesana COOPESALUD Coopesain
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