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Health Cooperative in Costa Rica: Costa Rica

In the previous post is completed cycle that describes the Cooperative Health System in Costa Rica, readers will find a model that while it was promoted by the Government itself (Social Security), encountered men omen m ready to realize this initiative and today, almost 20 years later, show how the cooperative sector organizations can successfully co-manage the provision of health services to the community a model of social security by the state, with a high level of satisfaction by users and even introducing initiatives that subsequently joined the Costa Rican health model as Ebais, the electronic record, etc.. The private initiative of a business model nonprofit evidenced when buying a private hospital, making it the first center of its kind in cooperative Central America, and developing prepaid medicine offers through companies owned by cooperatives. Existing cooperatives currently working together on a regional economic integration (second degree) called Consalud RL

Cooperative is understood that each course has its history and its own management, so the attempt to explain in general terms the model and some of the characteristics of each cooperative aims to illustrate successful models Cooperatives owned health care providers and shared ownership between providers and users, since the blog is not commercial and purposeful information and outreach, I hope to understand the shortcomings against the academic rigor that may exist, which are intended to meet with links to the various sources of information, including pictures and items of news on-line Nation. " " Prensa Libre" and "A Day " of Costa Rica that served to support this cycle. In summary, we presented the following issues, which can be accessed through the following links by clicking on them:

• Costa Rica: General Information, territorial organization and population data
• Costa Rica: Summary of System Current Health (I)
• Costa Rica: Summary of Current Health System (II)
• Health Cooperative in Costa Rica
• Costa Rica: COOPESALUD
RL
• Costa Rica: Coopesana RL
• Costa Rica: Coopesain RL
• Costa Rica: Coopesiba RL
• Costa Rica: San Carlos Borromeo Hospital Cooperative
• News Releases: Health Cooperatives and

has previously been published on the Health Cooperative in Brazil and Spain, which can be found at the following links:

• Unimed do Brasil System
• Health Cooperative in Spain

not forget, your feedback is important to improve this blog and if they consider their collaboration to enrich the subject matter thereof.

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Contents: Cooperative Hospital San Carlos Borromeo

This post is closed loop that is the subject of health cooperatives in Costa Rica, explained how the Integrated Health Cooperative RL the Consortium Consalud rescued from a financial crisis to the first private hospital that was born outside the Metropolitan Area, the District Quesada, Canton of San Carlos in Alajuela Province. Currently this Hospital is the first of such Cooperative, for those who administer the Health Co concessions are managed by cooperatives but publicly owned.

The Mount Sinai Hospital

The first private hospital that was born outside the metropolitan area in the district of Quesada (San Carlos Canton), appeared in 1993, involving than 80 shareholders, of which only 17 were physicians, in that sense, despite being a corporation, was characterized as a community initiative, as it joined various social and productive in the area. The hospital has since then all the services offered in any other medical facility, such as outpatient, emergency, internment delivery rooms, operating rooms, mammography, x-rays, among many others.

financial problems

Since its very beginning and throughout the years the hospital had multiple problems. Originally the project was worth ¢ 40 million (Or $ 76,923) and ended more than ¢ 100 million (or $ 192,308), which far exceeded the project's feasibility and left them, from the beginning with a huge debt. The infrastructure for the period were too many for the population of its catchment area, which was exacerbated by the lack of culture of the inhabitants of the region for private medicine, as people formed the view that an entity elitist and inaccessible economy.

One difficulty was the lack of administrative capacity (due to the lack of professionals in the area of \u200b\u200bhealth service management) to lead an organization of health and lack vision of the medical profession on how to conduct themselves in a private hospital, which was aggravated by poor workmanship, which was almost the same as Public Hospital (Hospital de San Carlos), limiting the availability of professional service. Thus, low customer, the restriction on the availability of services and the high financial burden for a debt of over ¢ 300 million (U.S. $ 578,000 approx.) Crisis in 1999 led to the institution.

After this financial crisis, the shareholders of the hospital began looking for alternatives to get out of economic problems. Two years later, after making fruitless to various entities, contacted the National Council of Cooperatives (CONACOOP) which in turn was able to interest the consortium Consalud RL on a project to save the hospital.

Consalud RL performed the feasibility study supported by the National Institute for Cooperative Development (INFOCOOP) , in which it was determined that the Northern Zone is the second nationally with the worst health conditions which was crucial to agree on April 26, 2002 the decision to undertake actions aimed at cooperativize the hospital by an agreement of transfer of ownership to Consalud RL, which will become effective when the latter cancels the debt that was dragging the hospital for ¢ 300 million (U.S. $ 578,000 approx.) the Cooperative Savings-Credit "Coocique" entity until then retain ownership of the shares by the figure of trust.

The Hospital Cooperative

In June 2003, RL Consalud began administering the hospital and after negotiating the debt and start the process to arrange the payment with Cooperative "Coocique" , an institution which holds the shares pledged, in December year Consalud Hospital officially reopened with a new name "Cooperative Hospital San Carlos Borromeo" making it the first health center in Central Cooperative.

In July 2004, after canceling the first ¢ 24 million (or $ 46,153) of ¢ 300 million (U.S. $ 578,000 approx.) Costing the hospital, the Consortium of Cooperative Health - Consalud RL, signed a contract for use of the Hospital, as a first step of the purchase of this medical center, the contract determines that while INFOCOOP approved total financing cost of the hospital, Coocique cooperative authorizing Consalud to give the use they see fit to benefit the population of the Northern and visitors who come to these locations.

Care Model: Alternative and Complementary System Health

The original idea with the Cooperative Project, being the only private hospital in rural areas of the country is open to all citizens of North Huetar to create a new cooperative with broad participation, where the benefits obtained for members to receive medical services deprived of excellent quality at lower rates than the private market and even with the possibility of funding, which is an excellent mechanism for low-income families. For this purpose, Consalud approaches forward in 2003 with the various unions, development associations, organizations and businesses with the aim of explaining the project's scope and to make agreements that allow the participation of partners and employees of these in the new cooperative health. Similarly, it seeks to sign agreements with the Social Security Fund , to provide additional services to which is already offered in the area.

Pending sealed the purchase process, Consalud RL have the hospital as the basis for operations of this system for Complementary and Alternative Health, with emphasis on hospital use by the cooperative specialized health services and social organizations. By June 2004, the hospital served about 70 people per day who offered services in all medical and other support services as laboratory, pharmacy, X-rays, among others. Consalud seeks to promote services to more people in order to cut costs, they must maintain a center open, with all services, 24 hours a day.

In this regard, in February 2005, Consalud made an agreement with the Savings and Credit Cooperative of Ciudad Quesada (Coocique RL), which involves the application of discounts of between 10 and 15 percent for health services to partners Coocique Cooperative received in the Hospital or other medical centers Consalud is in the Metropolitan Area, also Coocique opened a credit line to immediately, with interest at 23 percent annually and maximum terms of 5 years to finance medical treatments and hospitalizations. Consalud representatives hoped to establish similar agreements with other cooperatives and solidarity.

also proposed health promotion and disease prevention, through exhibitions that could be done in the medium term, taking into account the health of the Social Security Fund have problems of saturation in emergency rooms and waiting lists, and therefore, private medicine emerged as an alternative.

Area Cooperative Hospital service.

The Hospital is located in Ciudad Quesada, Costa Ricans also known as San Carlos. This is a small town but one of the major business centers and exchanges, to 2004 the population was 36,365 inhabitants. Ciudad Quesada is one hour by car (95 miles) north of the capital San José in the canton of San Carlos.

The canton of San Carlos is integrated into the North Huetar , which also includes the cantons of Guatuso, Los Chiles and Upala the province of Alajuela, canton of Sarapiqui Province de Heredia. In addition, the districts of San Isidro de Peñas Blancas, Río Cuarto de Grecia and Sarapiqui in the province of Alajuela. It has an area of \u200b\u200b9,603.4 km ² which equates to 18.4% of the country. In selecting this region as a special topic deprived two main criteria: (1) The request made to the project by civil society organizations in the region interested in a study to identify development trends and regional challenges and (2) the Huetar recognition of the North as one of the most dynamic country in the last ten years has developed as social productive, institutional and environmental concerns. According to Population Census 2004, the National Institute of Statistics and Censuses (INEC), the total population of North Huetar is approximately 243,031 inhabitants, the San Carlos canton which has a large number of people .

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Press Releases: The

www.prensalibre.co.cr

Cooperatives and health. Carlos E.
Serrano Rodríguez *

ancadis@ice.co.cr

The cooperative organization is part of the social economy of a country and as such contributes to human development and social development partners and the communities in which they are based. For one side are distinguished by its partnership dimension, to be established and controlled by a group of persons united voluntarily to solve common problems or needs, and secondly, has an entrepreneurial dimension in that it has to operate and grow in a market or particular and open environment, which operate demand productivity, profitability and competitiveness necessary to ensure social and business continuity.

Its essence is human and social because they are responsible for producing and supplying goods and services and quality assurance to its members, as well as the communities in which they operate. Contribute to local development, especially in marginal and rural areas that have the highest rates of poverty, facilitating access to basic services like housing, education, health, water and electricity, and promoting rural development or community as it presents a long-term investment that leads to greater stability in the interests and and commitments of associates and communities.

Regarding employment generation, create and maintain jobs particularly in economic sectors or geographical regions where conventional companies would struggle to create a value that would allow them to operate profitably, and also help to preserve jobs and existing, to allow producers to unite forces to save and plan their businesses.

Thus, there is a close relationship between the competitive and financially sound a cooperative venture with the generation of a more prosperous in the geographical area of \u200b\u200binfluence and the country. Its advantage for it, is based on the type of social relations of production characterized by the subordination of capital to the individual and the community and not the person to capital, allowing for equitable distribution of wealth combining efficiency social economic rationality as a principle of economics socialDurante the past four decades, with different emphasis, but with presence in various economic sectors and throughout the national territory, cooperatives have been one of the few sectors business partner, which by its territorial roots, have developed social and collective expressions of social participation mechanisms, enabling access to factors production, in a self-managed and collectively, minimizing problems of exclusion and concentration, promoting private initiatives by the private will of partners and associates. Increasingly united capital have a greater impact on the economy, although it does not like certain areas of interest.

One of the problems faced by cooperatives is referred to the multiplicity of interests that arise in the environment, characterized by a set of latent pressure groups and powerful in pursuit of business profits are sparing no resources to damage the image of the associative organization. Today batteries are inching toward health cooperatives, public affairs area in which they move many interests, which even if it has not imported much damage to social security institution in the country, the less they matter recognize the success of community health service, expressed in the Ebais, which was an innovative way to address the need for public health. If

well after an operation time of Ebais, the service has fallen on hard times or has become a repeat of the inefficiency of the Fund for its distortions planned, this does not justify removing the target service for a purely financial. On the contrary we must strengthen, improve, extend schedules and specialty care to avoid dating one year term (as if the disease could be expected). Remember that clinics and hospitals are overwhelmed box and people are dying from lack of attention, which has facilitated the presence of "screens" and corruption. Many of the criticisms that were made to the service are based on inadequate terms reference of contracts and lack of performance indicators and the regulation and control by the Fund. Management should improve quality and control and demand more efficiently, using the Public Procurement Act and the option of direct contracts, but not destroy the good that has been achieved through the social economy. Private medicine has its resources to grow, but it should do so by destroying the Fund and health cooperatives.

* Carlos E. Serrano Rodríguez, is Professor at the School of Public Administration, researcher and professor of the Master of Public Administration University of Costa Rica.

Posted in The Free Press, February 6, 2007, page 17 of the print edition and online edition at: http://www.prensalibre.co.cr / 2007/febrero/06/opinion04.php

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health cooperatives and Costa Rica: Costa Rica Coopesiba

History Health Cooperatives in Costa Rica is tied to the experiment that the capitation payment CCSS conducted in Barva de Heredia, the incredible thing is that since 1988, based on this assay, we created 3 successful cooperatives in other regions and only in 1998 a company was consolidated Health Cooperative in the region following the failure of this pilot project and the Cooperative Medicoop.

Background.

the late '80s the Social Security Fund (CCSS) was in the low efficiency of the outpatient or ambulatory one of the most vexing problems, hence, when in 1987 he found it need to introduce new models of care to decongest the outpatient and facilitate access to services and individual workers, strengthening the created "Medical Company" (the company pays the doctor's fee and covers CCSS medications and support services) and "Joint Medicine" (the patient pays the doctor's fees and offers CCSS medicines and tests cabinet.) At the time that previous models were introduced, and seeking to promote competition and preventive activities, we initiated a pilot Center Community Integrated Barba de Heredia with medical association Acepromazine, to use for the first time, a model of "Capitation Payment" which consisted of assigning a certain number of patients to physicians, according to free choice of the insured, calculating physician compensation based on the insured assigned; CCSS paid to the association of medical services per capita, and the association paid physicians based on the services provided to patients, in addition to The CCSS and Ministry of Health gave the local , equipment and put other staff.

This pilot faced a number of management challenges for its experimental nature, not by the quality of service as management problems, as the staff of the CCSS and Ministry of Health that worked in the medical center and integrated association had contracted capitation schedules and institutional cultures that failed to be harmonized, causing dissatisfaction among the insured and local leaders asked him CCSS to reassume direct provision of services ; well established payment mechanisms were challenged by the Comptroller General of the Republic. Despite the failure of the pilot, the experience gained in Barva de Heredia was the basis for the CCSS introduced the Cooperative to provide services health and this is how in the year of 1988 promoted the creation and subsequent recruitment of Cooperative COOPESALUD RL to administer the new Pavas Clinic and served under this mode of payment and the family medicine approach to Pavas community, then in 1990, another cooperative, Coopesain RL, started in similar conditions, the provision of services in the canton of Tibás.

Seeing the success of Cooperatives COOPESALUD and Coopesaín Pavas and Tibás respectively, and after lengthy discussions, the community, medical staff and local authorities in Barva de Heredia , CCSS agreed to set up a cooperative similar to the above to make a contract similar to that carried out Pavas and Tibás. With 16 physicians who participated in the original pilot in November 1992 was the cooperative Medicoop to serve the community in the cantons of Barva and San Isidro, Heredia Province and part of the province of Alajuela. The Cooperative Medicoop not met the expectations of better service to both the community had CCSS.

born Self-Management Cooperative Integrated Health Services Coopesiba RL Barva

After several attempts at reorganization of the Integrated Center, CCSS decided to insist supporting the formation of a new cooperative, Coopesiba RL, which began in February 1998 to serve the communities of Barva, San Pablo and San Isidro, for which the CCSS gave him a building that the municipality had given Barva in 1996 and 13 Ebais.

In November 2005, the city of Barva took action to collect from the CCSS the value of ¢ 2 million (U.S. $ 3,850 approx.) Monthly for the rent for the premises where work Coopesiba ; to the indifference of the CCSS , the municipality wanted to leave the Cooperative, a situation finally settled on 6 November 2006 when the CCSS reached an agreement with the Municipality of Barva to the local clinic follow operating in the City Hall building. As part of the agreement, the municipality demanded the CCSS present the plan to build the new headquarters Barva health.

Beneficiaries

currently serves a population of 60,734 inhabitants (37,378 inhabitants. In the area of \u200b\u200bBarva and San Pablo 23,356), which corresponds to 1.4% of the population national in 2006 was ¢ 20,186 for each user assigned and between 1999 and 2006 CCSS authorities issued ¢ 6.147 million in payment for health services. The CCSS evaluates and rates each year to individuals who contracted to provide health services, the most years exceeded Coopesiba 90. In December 2006, the Cooperative extended its contract for 2 years.

Cooperative Management

Coopesiba In only 57 of 134 workers are partners, to join must be working for several months, take courses and make the request to the assembly, which meets once a year but not all send the request and some employees work or have worked for the CCSS , as in the case of general exgerente Coopesiba , Daisy Corrales, who was an officer of the CCSS who asked for a leave without pay, as general manager, Corrales signed the first Coopesiba management commitment, in 1998, and currently works again CCSS in Medical Management.

Join together with other cooperatives in the Consortium Consalud RL, in June 2003 the hospital began operation of a private cooperative in the district of Quesada (San Carlos Canton), the first of kind in Central America (as opposed to clinics that administer cooperatives, this hospital is owned by the cooperatives formed in the consortium).

To complement and understand the role of RL Coopesiba in the health system in Costa Rica can consult the following links:

• Health Cooperative Costa Rica.


• Summary of Current Health System (II).

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