[Espriu foudnation]: Healthcare cooperative


In Spain, the national health system was established during the late 1980s then reformed in 2011. The system was a centralized, bureaucratized system with non-universal coverage, which was funded by wage-linked social insurance for illness. But after 1986 (because of the effect of the General Health Law enactment), it has changed to decentralize into the seventeen autonomous communities with universal care and funded by the general taxes. It means each regional government has its own administrative and management body responsible for all the health centers, services, and facilities in its region.

However, after the 2012 recession, there were reforms reduced universal coverage, excluding large sections of the population from protection. It had served as a momentum to strengthen the role of health cooperatives, such as the Espriu Foundation, a health service provision system based on an organizational vision of the health sector open to cohesive and shared administration, committed to a social concept of health care which does not pursue corporate profit but places the patient at the heart of its approach.

In Spain, there are various types of cooperatives in the medical sector, such as worker’ cooperatives, consumer cooperatives and service cooperatives. In the case of the Espriu Foundation, it is established in 1989 as a private non-profit organization, and it has been placed the third in the global rankings of health cooperatives. The foundation has pioneered the creation of a comprehensive cooperative health care model before the systemic health care system was established in Spain. This historical model was inspired by Dr. Espriu’s experience of the medical system of Bilbao. Since there was no universal public health system, many people, especially in rural area couldn’t include in the national health system. However, in Bilbao, people can serve the medical service due to the ‘iguala’ (Igualatorio de medicos de Bilbao), which was defined as a type of private medical insurance whereby residents paid an amount established in agreement with a doctor to the latter every month via the iguala and received medical care in return. Due to the iguala doctor could be certain of the monthly payments that they would receive without depending on the progress of their patient’s health. This system was the inspiration to Dr. Espriu making the decision to disseminate it to the Basque region and to the whole regions of Spain. 

(Moncloa (left) / SCIAS (right) Hospital)

Utilizing this idea, Dr. Esprius, along with his colleagues, founded the insurance companies ASISA in 1962 and the SCIAS medical cooperative in 1974. This first cooperatives were created to expand the scarcity of medical facilities and to provide quality medical services to providers and users themselves. The Autogestió Sanitària service cooperatives, founded in 1974 and composed of doctors belonging to the local medical association in association with ASISA and SCIAS, was established in 1989 as a non-profit the Espriu Foundation to effectively provide comprehensive health care services in a cooperative manner. The Lavinia cooperatives established in 1977, with medical staffs, belongs to the foundation. According the latest information, the total number of cooperativist members was 182,850, including 38,766 doctors and 45,338 employees, and exceeded 1,684 million EUR, and the group’s total assets amounted to 742,139,090 EUR in 2015.

The Espriu Foundation could be considered as a new medical movement which is pursuing the ’comprehensive health cooperativism’ in Spain. The Healthcare cooperativism is seen as an alternative that complements the public social security system. It has been constructed the new relationship between doctor-patients, medical activities that do not pursue only profit. The most important value of this movement is that through the cooperative form, it voluntarily presented new alternative relationships to the dominant structure of the existing doctor and patient relationship, and uncovers unresponsive areas in the state and the market.

* This review indebted to cooperative health report 2018 ‘Assesing the worldwide contribution of cooperatives to healthcare’ by ICA International Health Cooperative Organisation COOP and Euricse (2018) particularly Chapter 6: Spain: Fundación Espriu, best practice of solidarity and shared management’ (full report is attached). Also checkout Espriu foundation website: Link