The president of the FAESS, and Board Member at the International Health Co-operatives Organisation (IHCO), Ricardo López announced that the sector was working towards the creation of Unisol (Solidarity Union Network). This network would be "a collective safety net" providing greater protection than a federation, and would serve to extend prevention campaigns and offer an improved service to those individuals overlooked by commercial healthcare. "How many commercial enterprises engage in prevention? We form no part of the sickness business," asserted Dr. López.

The forum was attended by Dr. José Carlos Guisado, Espriu Foundation's Trustee and IHCO's President, who explained the current situation of the co-operative health model in Spain and its connection with public health.

The Espriu Foundation was represented by its President, Teresa Basurte, and by its Chief Executive Officer, Dr José Carlos Guisado. The event was likewise attended by the Speaker of the Spanish Parliament, Jesús Posada, the President of Cepes, Juan Antonio Pedreño, and the President of the Spanish Parliamentary Committee on Employment and Social Security, José Eugenio Azpíroz, along with numerous parliamentarians from the various political groups in Congress, and representatives of the co-operative movement from throughout Spain.

The General Assembly of the United Nations declared 2012 to be International Year of Co-operatives, highlighting the contribution made by co-operatives to socio-economic development, and in particular acknowledging their impact in reducing poverty, generating jobs and achieving social integration.

He later met with Dr José Carlos Guisado, Espriu Foundation's CEO, who provided him with extensive information about the activities and interrelationships of the institutions which make up Grup Assistència and Grupo ASISA. At their meeting they likewise exchanged opinions and experiences about different aspects of co-operative and hospital management, and debated lines for collaboration in the future between the Espriu Foundation and the Argentine Federation.

FAESS as an institution aims to bring together users and health providers in order to achieve implementation of a health service model based on solidarity, focusing on co-operatives, mutual societies and other socially committed sectors, governed by the principles of cooperation. It is an associate of the International Health Co-operative Organisation, IHCO, and its President, Dr Ricardo Lopez, likewise sits on the organisation's Board.

Juan Antonio Pedreño, who was re-elected during the assembly as the President of CEPES, announced that it will shortly be presenting the First Pact for Social Economy Employment and a Programme to Promote Social Entities, in order to add flesh to the bones of the recently passed Social Economy Act. Pedreño also announced that he would be «working to ensure that CEPES is involved in social dialogue, so as to create the conditions allowing Social Economy enterprises to contribute their full potential through the construction of public policy in co-operation with all other social agents, given that it is the responsibility of all to resume as soon as possible the pattern of growth which Spain needs».

In her presentation Ms Vidal set out a view of social enterprise as an initiative derived from an association of people, as opposed to business initiatives motivated by the association of capital, opting for a distinctive organisational model in providing goods or services. This model is based on principles such as the pursuit of shared benefits, the involvement of the different stakeholder groups in corporate governance (citizens, workers, consumers, etc...) and the reinvestment of any surplus funds to improve sustainability of the business.

The Barcelona University lecturer explained that the SCIAS co-operative, one of the constituent bodies of the Espriu Foundation, represents a key example of a social enterprise, stressing its system of corporate governance, a multi-stakeholder model which involves both workers and consumers in their capacity as members.

Photo: From right to left,  Gerard Martí, Espriu Foundation's Trustee, Isabel Vidal, CIES President, Teresa Basurte, Espriu Foundation's President  and Lourdes Mas, Scias Manager

The new federation, chaired by Dr. Yasuyuki Takahashi, is a co-operative organisation grouping together and serving Japanese co-operatives engaged in the provision of medical and health care services, providing nursing care home and aged people care or administering any kind of health care facility, such as hospitals, primary care clinics and rehabilitation facilities.

During its first year in operation the federation has successfully brought together 115 co-operatives, representing more than 2,710,000 members. It has 78 hospitals, with an overall capacity of 12,500 beds, and more than 900 facilities ranging from primary care clinics to dentistry practices, rehabilitation centres, etc.

Co-operative legislation in Japan demands that co-operatives perform the bulk of their economic operations exclusively among their members, placing almost complete restrictions on access to the non-member market. There is, however, a certain margin for co-operative action within the health sector, as the law allows services to be used by third-party non-members up to a limit equivalent to one half of the co-operative's turnover. HeW Coop Japan has nonetheless been engaged in an intense campaign to convince health service users of the benefits of co-operative membership, persuading 80% of health co-operative users to become members and take part in the organisation's daily affairs.

This membership success is largely the result of numerous initiatives organised by the federation focusing on its grassroots members, above all addressing prevention and health promotion and the involvement of volunteers in charitable programmes.

Particular mention should also be made of other federation actions including those focusing on the corporate administration of co-operatives, such as training programmes for co-operative staff, support and consultancy on management systems and coordination among associate co-operatives for the joint purchasing of medical and pharmaceutical materials.

Dr. Ricardo López, a member of the Global Council of the International Health Cooperatives Organisation (IHCO) and chairman of FAESS (the Argentinian Federation of Social Health Organisations) spoke at the seminar to set out the vision of health cooperatives with regard to such vital issues as the health economy, the funding of health care systems and the expansion of the social safety net.

A number of the presentations can be viewed on the ISALUD Foundation University website.

Dr. Martí then accompanied the Brazilian co-operative members on a visit of the hospital's facilities, giving them the chance to find out about some of the most innovative apparatus with which the hospital is equipped.

The logo is based on the slogan and evokes the definition of cooperative enterprises as autonomous associations of persons united voluntarily to meet their common economic, social and cultural needs and aspirations, through a jointly owned and democratically controlled enterprise. It makes the underlying declaration that economic viability need not be divorced from social responsibility.

The United Nations General Assembly declared 2012 as the International Year of Cooperatives, highlighting the contribution of cooperatives to socio-economic development, in particular recognizing their impact on poverty reduction, employment generation and social integration. «Cooperatives are a reminder to the international community that it is possible to pursue both economic viability and social responsibility» said Ban Ki-moon, UN Secretary-General.

The International Cooperative Alliance is rolling out a branding awareness campaign linked to 2012 International Year of Cooperatives. «Co-operatives are an important business model being values based and IYC is the beginning of what will be an on-going marketing campaign that will ensure people understand what incredible potential Cooperatives have as a solution for today's challenges» said Charles Gould, ICA Director-General.

Two days later, on 19 May, the delegation moved on to Barcelona to attend a working session held at Hospital de Barcelona. During the event Dr. Gerard Martí, Deputy Medical Director of Hospital de Barcelona and one of the Espriu Foundation's trustees, gave a presentation dealing with the concept and functioning of the co-operative hospital where the workshop was staged, along with the activity and relationship which exist among the institutions which make Grup Assistència. The delegates at the meeting exchanged opinions and experiences on different aspects of co-operative and hospital management and raised a number of possible future forms of co-operation between the Espriu Foundation and Mato Grosso's health co-operatives.

Dr. Martí then accompanied the Brazilian co-operative members on a visit of the hospital's facilities, giving them the chance to find out about some of the most innovative apparatus with which the hospital is equipped.

The text passed by the Spanish parliament is the result of a process which lasted more than 3 years, since September 2007 when Marcos de Casto, the then President of CEPES (the Spanish Confederation of Social Economy Enterprises) declared before the Parliamentary Sub-Committee set up "to examine the situation of the social economy in Spain" the need for a legal framework to govern the sector. A group of experts from CIRIEC (International Centre of Research and Information on the Public, Social and Cooperative Economy) subsequently drew up a proposal which they submitted to the Ministry of Employment in December 2009. In July 2010, the Council of Ministers gave its approval to the White Paper, which was then put before Parliament, receiving final approval with the consent of all Parliamentary groups.

The Act represents a considerable step forward for the sector by defining the social economy as "the set of economic and business activities which within the private sphere are undertaken by those organisations pursuing either the collective interest of their members or general economic or social interests, or both".

The guiding principles established for social economy organisations are the primacy of people and a social purpose over capital. This takes the specific form of independent, transparent, democratic and participatory management, giving priority in decision-making to the role of people and their working contributions with regard to stakes in the capital stock. Provision is also made for the application of the profits earned, essentially in accordance with the work contributed by the partners or by their members; the promotion of internal and social solidarity in order to underpin a commitment to local development, equality, social cohesion, the inclusion of those at risk of exclusion, the generation of stable, quality employment, a balance between personal and professional life and sustainability, along with independence of public authorities.

Article 5 of the Act sets out a catalogue of those organisations which belong to the social economy, making specific mention of cooperatives, mutuals, foundations and associations engaged in economic activities, worker-owned companies, job creation enterprises, special employment centres, fishermen's guilds, agricultural transformation companies and organisations created under specific regulations governed by the principles of the social economy. Nonetheless, each social economy structure will be governed by its own specific practical regulations.

The Act in its own words "recognises as a task of general interest the promotion, stimulus and development of social economy bodies and their representative organisations", while also setting targets for public authorities in their policies to promote the social economy by simplifying the administrative procedures involved in setting up this type of organisation, facilitating initiatives, promoting the principles established in the Act, encouraging professional training within organisations, involving them in active employment policies and introducing references to the social economy into curricula, among others.

The Spanish Confederation of Social Economy Enterprises, to which the Espriu Foundation belongs, has registered its satisfaction at the passing of this Act which "will give the sector the place and status it demands given its importance within the Spanish economy, while also representing a historical landmark, as the first such legislation to be established anywhere in the world". According to representatives of social economy employers, "this Act forms part of the commitment of Spanish President, José Luis Rodríguez Zapatero, to CEPES with the aim of underpinning the sector and facilitating its involvement in the creation of public policy".

The Government has itself stressed the importance which it gives to the sector in drawing up the legislation. The Minister of Employment, Valeriano Gómez, described the Act as "pioneering", pointing out that the regulations "are not simply legal window-dressing", but are "born out of a widespread conviction regarding the need which existed, as reflected in the broad consensus which has been established and thanks to which the Act was ultimately passed".

The legislation serves within the context of company law to improve the economic and social position across the European Union as a whole, removing obstacles from the internal market and encouraging development across regions and Member States using the cooperative system, without the need to set up different corporate operations in order to engage in cross-border activities.

The main aim of the European Cooperative Society is to satisfy the needs of members and to develop economic or social activities in accordance with the cooperative principles of democratic participation and equitable distribution of net profits, with no obstacles placed on membership. The recently approved Act will undoubtedly help contribute to the extended application of the European Cooperative Society Statute on behalf of respect for equality of terms in competition and economic development as pursued by the European Union, thereby providing cooperatives, organisations which are commonly recognised in all Member States, with appropriate legal instruments facilitating the pursuit of their cross-border operations.

The passing of the Act clarifies certain aspects regarding the legal framework, standardisation, registration and publication of documents, transfers to other Member States and corresponding objections, specific aspects regarding mergers and transformations and options within the management system. It thus resolves the difficulties involved in the regular references in the European regulation to the cooperative legislation of the Member States.

One of the most important impacts which this new legal text will undoubtedly have is the recognition of this corporate structure in Spain and all that entails. A European Cooperative Society based in Spain becomes a new regulatory instrument for cooperative collaboration and integration, as well as a new instrument at the service of the cross-border ties between cooperative societies, but also a cooperative formula for economic collaboration among different European economic operators.

In short, a new tool with which to overcome the obstacles imposed by borders and facilitate development across regions and states which will now be able to overcome the shortcomings which other corporate structures have in international operations thanks to the cooperative approach.

The sectoral adaptation of the standards to cooperative accounting were recently approved. However, this adaptation was not without controversy, given the treatment applied to the assets structure of cooperatives. The main aspect for consideration refers to the capital stock of cooperatives, which may be classified as equity, liabilities or a compound financial instrument. The ninth registration and valuation standard states that "financial instruments issued, incurred or assumed shall be classified as financial liabilities, in whole or in part, wherever in accordance with their economic reality they represent a direct or indirect contractual obligation for the company to hand over cash or another financial instrument, or to exchange financial assets or liabilities with third parties on potentially unfavourable terms, such as a financial instrument which provides for a mandatory repurchase by the issuer, or which grants the holder the right to demand its redemption by the issuer on a date and for a specific or specifiable sum, or to receive predetermined remuneration provided that there are profits which may be distributed". For cooperative societies this means that the members' contributions, until such time as the society grants an unconditional right to reject reimbursement, become partially classified as liabilities, with a corresponding reduction, for accounting purposes, in their equity.

This provision has been in force since the start of the year, meaning that cooperatives have until the end of the year to take the relevant decisions and modify their articles of association in accordance. If the assembly rules that members' contributions are to lose their capacity to be automatically reimbursed if the member leaves the cooperative, then those contributions could be entered in the accounts as equity, but will otherwise be classified as a liability, in other words as a debt owed by the cooperative to the member, irrespective of their legal consideration.

The selected business case studies are all from the Social Economy market subsector. They were chosen by the Spanish Business Confederation of Social Economy (CEPES), based on business location and market sector criteria from among innovative and successful companies that stand out for their organisational capacity, their market implementation, their social approach and their efficient management of processes and products.

The report stresses that «the Espriu Foundation can teach us how cooperative values can be extended beyond the collective itself. The institutions of the Espriu Foundation were initially promoted by doctors; however, these are only 50% of the project, given that health service users have also been taken into account. The Espriu Foundation has always taken into consideration that health services are a basic right, and that society needs the health system to provide quality services. In addition, it should be the doctors themselves who really provide these services in a pleasant, dignified and satisfactory manner. It is a win-win scenario, where both sides win.»

One of the conclusions of the report, as regards the Espriu Foundation, is that the key to success lies in the collaboration between the providers of a service and its recipients, favouring the creation of sustainable social value. The report argues that «the pooling of needs and preferences of providers and clients, grouped around an organisation with strong cooperative values, can create full value in the long term, exceeding the financial benefits that would be obtained with a general commercial model.»

The Report concludes with a series of «transversal lessons», based on the common characteristics of the bodies analysed. One of the most noteworthy lessons is that Social Economy companies differ clearly in their map of values from ordinary companies controlled by capital; they are focused on long-term feasibility, based on satisfying the needs of their clients; they generate a high number of jobs; they are committed to quality in production processes, as a guarantee of sustainability; they are linked to their territory, rather than other more impersonal concepts and have a high rate of networked collaborative work.

The final conclusion of the report is that social economy and sustainable business feasibility come naturally when social values, entrepreneurial people, flexible organisations and work well done are all brought together.

Before joining Volunteers of America, Mr. Gould practiced as an attorney-at-law with a number of US law firms. He has a Juris Doctor (JD) degree from the University of Minnesota Law School (USA), and a Master of Studies (MSt) in International Human Rights Law from Oxford University (United Kingdom).

Throughout his career, Mr. Gould has underscored the importance of projects involving collaboration between institutions and companies and on the use of technology as tools to improve the organizational effectiveness. Due to this he has been recognized in the past five years as one of the fifty most influential leaders in the non-profit organization sector in the United States.

The new, ICA Director General -who took up his post in September-has stated that "it is a privilege to participate in the management of an institution that combines the inheritance of more than a century with a business model that has never been more relevant than it is today." In his presentation message, Mr. Gould supported the idea of celebrating the International Year of Cooperative in 2012 as "a platform to tell our story," thus taking advantage of the opportunities that this event will bring and that are not usually available.

Pauline Green, ICA president, when announcing his appointment, stated that "The ICA Board recognizes that, the United Nations having designated 2012 as the International Year of Cooperatives, we need a leader that can successfully use this platform to communicate the values of cooperatives. Charles Gould has proven that he has the passion both for a vital mission and the necessary knowledge to take an organization to a higher level."

Dr. Francisco Ivorra, President of the Espriu Foundation and ASISA, stated that the Torrejón Hospital concession is "recognition for ASISA's experience managing administrative contracts in Spain and for the public-private collaboration model developed in the Autonomous Community of Valencia".

The line of Hospitals in Torrevieja and Vinalopó, the management of which ASISA participates in, will be equipped with the latest technologies and will be a completely computerized, integrated, accessible and safe centre with a highly skilled multidisciplinary staff providing healthcare of the highest quality and will offer benefits to the professionals that work there.

For the President of ASISA, "participating in this public hospital project integrated into the public healthcare system of the Autonomous Community of Madrid is reason to be proud and it is a great challenge to make it so that this public centre, which is based on the public-private collaboration model, is a public centre of reference for all Madrid residents".

The President of Assistència Sanitària, Dr. Ignacio Orce, and the Dean of the University of Barcelona, Dídac Ramírez, have signed a strategic cooperation agreement which shows the interest of both organizations in creating ties and collaborating in the teaching, education and participation of health care professionals. Taking advantage of the synergies between the two entities, the idea is to combine care giving with teaching and research, thereby creating a vehicle to attain excellence in the Catalan health care system. Specifically, the projects will focus on actions related to neonatology and paediatrics, assisted reproduction techniques, management of health centres and organizations, molecular bio-pathology and collaboration between public and private health care.

The framework agreement also sets up the second edition of the Assistència Sanitària Grant Programme, which will benefit students in the third cycle of health education with an aim to improve their professional qualifications and facilitate job placements. With a 30,000 euro fund, the assistance will pay for 50% of the amount of the registration fees for master's or postgraduate programmes (includes more than 200 official and university-specific degrees) and will be granted to doctors and nurses who study during the 2009-2010 academic year. In an effort to support medical professionals and participate in their continuing education, the grant programme is aimed at third cycle studies so that the impact on the profession is practically immediate, with special emphasis on nursing in recognition of work that is essential to the proper functioning of the health care system.

Besides study grants, Assistència Sanitària will collaborate with UB teaching master's, doctoral, post-graduate and research courses, fostering student and instructor exchanges in order to enrich their knowledge and skills. Other joint debate and experience exchange actions will be planned such as sharing information on research topics, publications, seminars, public events, presentations, conferences and teaching materials.

The resolution, which was supported by 55 UN member states, calls upon governments and international institutions to support and foster the development and growth of co-operatives throughout the world and calls upon them to review their laws on co-operatives in order to guarantee their growth and sustainability.

Together with the international co-operative movement, the United Nations invites governments to "develop programmes aimed at enhancing capacity-building of co-operatives, including by strengthening the organizational, management and financial skills of their members, and to introduce and support programmes to improve the access of co-operatives to new technologies".

The United Nations defines the co-operative as an autonomous voluntary association of people who unite to meet common economic, social and cultural needs and aspirations through a jointly-owned and democratically-controlled enterprise.

Currently, the co-operative sector is made up of nearly 800 million people from more than 100 countries and it is estimated to provide more than 100 million jobs. A 2008 report by the International Co-operative Alliance states that the three hundred most important co-operatives in the world have a turnover of 1.1 billion dollars, which is similar to the turnover of the entire Spanish economy.

The purpose of International Years declared by the UN is to draw attention to major international issues and encourage action. To commemorate the International Year of Co-operatives, international and regional conferences will be held and national programmes will be established to foster and develop co-operatives.

On 13 October, a group of doctors and executives from the Unimed medical cooperatives in the Brazilian state of Minas Gerais, participated in a work day held at the Hospital de Barcelona.

The session began with an introduction to the foundational goals, objectives and activities of the Espriu Foundation. After this, Dr. Gerard Martí, Deputy Medical Director of the Hospital de Barcelona and trustee of the Espriu Foundation, made a presentation that covered the concept and functioning of the cooperative hospital where the session took place as well as the activities and interrelationship between the institutions that form the Grup Assistència.

The President of the Xunta de Galícia (Galician Government), Alberto Núñez Feijoo, presided the opening act of the annual General Assembly, accompanied by regional Health Minister, Pilar Farjas. Also present were the main directors of Lavinia and Asisa.

After thanking Lavinia for having chosen to hold its XXXIII Annual Assembly in Corunna, in his speech, Núñez Feijoo highlighted the commitment of ASISA-Lavinia to healthcare quality, the result of the vocation of its professionals and the constant modernisation of its facilities.

The session opened with the presentation of the president's report and the financial and management report for 2008 for Lavinia and ASISA and its group of companies, which were approved unanimously.

Subsequently, the assembly examined all issues of interest to members dealt with in the preparatory provincial meetings, especially those related to healthcare provision, which were all answered, and their resolutions were approved by the assembly.

The assembly also examined different reports related to the management of the company, as well as to new business approaches, all of which received the backing of those present at the Assembly.

After choosing Tarragona as the venue for the next assembly, the secretary of the Board of Governors, Dr. Antonia Solvas, informed those present that the agreements adopted in previous assemblies had been implemented throughout the year.

The results presented in the assembly show that ASISA the closed financial year 2008 with an increase of 5.47% of its income with regard to previous years, which represents a turnover of 780 million euro, of which 760 million euro correspond to insurance premiums.

The company has devoted a total of 653 million euro to providing healthcare services, an increase of 4.41% with regard to 2007. Medical fees have increased by 4.55 % compared to the previous year, and amount to 306 million euro. This amount represents 40.6% of income from premiums, that is, the fees paid via personal healthcare services represent more than 10 percentage points above the average for the sector.

Basurte was accompanied by the secretary general of the Board of Governors, Enric Sells, and the director general of SCIAS and manager of the Hospital de Barcelona, Lourdes Mas. The event was attended by 105 delegates representing more than 900 members who had attended the 22 preparatory meetings held throughout the year.

In her opening speech the president mentioned that it is Hospital de Barcelona's 20th anniversary this year, and highlighted the fact that "despite the current crisis, we can still maintain the standards of quality, technology, comfort and, especially, humanity, to which we committed at the time of its foundation".

After naming the two mandatory auditors, the assembly started with a viewing of the president's report. Among other aspects, Teresa Basurte highlighted the opening of the Day Hospital for oncological treatments, the publication of the Oncological Pharmacotherapy Guide, the application and improvement of the Register of Tumors, and the increased importance of Outpatient Surgery, which now represents 56% of all Programmed Surgery.

As to the investment made, the report highlights the addition of new Nuclear Magnetic Resonance and Digestive Endoscopy equipment, the refurbishment of the lighting and bathrooms of two hospitalisation units and the refurbishment with improved technology of diagnosis, surgery, hospitalisation, general services and catering equipment and several installations aimed at reducing the power consumption of lighting and air conditioning.

In general terms, the number of SCIAS user members went down by 1,956 in 2008, to 167,254. According to the president, this could be attributed to the current financial crisis. Financially, the institution obtained a surplus of 55,781 euros, as certified by its accounts controller, Carles Ramos. The assembly unanimously approved the annual accounts and agreed that 65,000 euros should be provided to the Fund for the Promotion of Education and Cooperativism, through which it contributes to financing the Espriu Foundation, and the rest to the Obligatory and Voluntary Reserve Fund.

With regard to clinical activities, in 2008 the institution's medical services provided healthcare to a total of 147,719 patients, 15,387 of whom were admitted to the Hospital de Barcelona, 6,852 were seen to in the walk-in surgery, 46,304 in the Emergency Service and 73,359 at their homes via the Home Emergency Service.

The General Assembly continued with the renewal of the annual contract for external auditing with Mazars Auditores and with the approval of both the modification of the Articles of Association and the renewal of the Work Members Internal Regime Regulations, concluding with the election of the new members of the Resources Committee: Pere Torné Roig, Josep M. Antich Sorli and Martí Llorach Torres; as well as of the members of the Board of Governors: Montserrat Caballé Domènech, M. Teresa Basurte Calvo, M. Àngels Font Sardà, Josep Plaza Clotet, Francesc Fornell Carbonell, Natàlia Mimó Estany, Lucia Ortega Enciso, Enric Sells Bruguera and Joaquim Serra Trias. Delegates participated actively during question time, which centered on minor issues, given that, as one of the attendants stated, "regarding medical issues, everyone is quite satisfied".

ASISA's commitment lies in conducting diagnostic tests on all patients who are part of the risk group, as well as assisting with check-ups.

Moreover, a mixed integrated commission has been created with representatives from ASISA, the City of Madrid, the Tejerina Foundation and the Spanish Gastroenterology Association. This commission will guarantee the proper development of the project and the best quality service.

The CEO of ASISA, Dr. Enrique de Porres, who inaugurated the Conferences along with the Director of the newspaper Diario Médico, explained that sponsoring this event is part of ASISA's interest in understanding sector problems and encouraging an exchange of experiences among its professionals.

For his part, the Manager of the Hospital de Torrevieja, Dr. Luis Barcia, focused his presentation on the development of the Hospital Information Systems and, especially, on the computerized clinical history project "Florence", a pioneer experiment undertaken at this hospital.

Dr. Juan José Fernández, Managing Director of the Clínica Moncloa, presented the project "Integra", which has been implemented in this centre to facilitate access for healthcare professionals from other countries.

On the second day, Dr. Luis Mayero, provincial representative of ASISA in Madrid, debated along with representatives of private clinics and other health insurers the challenges they must face together in order to optimize their relations.

For the Managing Director of Ribera Salud, Alberto de Rosa, the hospital of the future will follow in the footsteps of the Hospital de Torrevieja or the Hospital de Valdemoro. He stated that the success of this cooperation is based on that it "generates values such as efficiency, modernity and better management".

For his part, the CEO of ASISA, Dr. Enrique de Porres, asked that there be an in-depth debate on this model and assured that these formulas are a sure success in Spain because there are strengths that will make it possible to expand them, as is the case of maintaining the health insurance companies as partners because they have experience, guarantee their financial solvency, have broad territorial coverage and a good public image. De Porres said that public-private cooperation is not only possible and necessary, but "in order for the system to truly be efficient, it is a must".

Orce has presided over various entities linked to health co-operatives such as the Montepío de Previsión Social de Asistencia Sanitaria Colegial, Asociación Española de Igualatorios Médicos Colegiales, Autogestió Sanitària, BIOPAT and Asistencia Sanitaria Colegial. He has been trustee of the Espriu Foundation since 1989 and since 1988 has acted as coordinator and spokesperson for the Grup Assistència, a forum that practices equal co-management among doctors and users.

Photo: Dr. Gregorio Medina, provincial representative of ASISA, bestow the award upon  Dr. Orce

The Government delegate in Andalusia, Juan José López, presided over the award ceremony which, among others, was attended by the Deputy Mayor of Revenue, Nieves Fernández; the Chairman of the Espriu Foundation, Dr. Francisco Ivorra; the CEO of ASISA, Dr. Enrique de Porres; the provincial representative of ASISA in Seville, Dr. Gregorio Medina; and the Director of the Clínica Santa Isabel, Dr. Francisco Vázquez.

This award, which is traditional in Andalusian healthcare, is bestowed through a popular vote by the 1200 ASISA medical professionals in Seville. This is the way they acknowledge the work done by one of their colleagues in the sector. For this edition, the ASISA doctors wanted to recognize the career, professional commitment and human nature of Dr. José María Nieto, who currently directs the Seville Medical Board Foundation and has been a member of Asistencia Colectiva de la Organización Médica Colegial since 1998.

The prestigious journal Diario Médico has granted the ASISA-Lavinia Committee for Bioethics and Healthcare Rights one of its awards “to the best ideas in 2008” in the Legal, Ethical and Guidelines category. This is an innovative initiative that arises from the consultant and interdisciplinary body, to provide council for ethical and legal aspects and conflicts that arise in the clinical practice. This Committee, pioneer in this field within healthcare companies, advises the different healthcare institutions within ASISA, the healthcare professionals included the list of doctors and other institutions involved in the healthcare activity or in the related healthcare training.

The Committee for Bioethics and Healthcare Rights is made up of three experts in the field. These are Fernando Bandrés, Manager of the Tejeri Foundation Advanced Studies and chief professor of legal medicine at the Universidad Complutense in Madrid; Benjamín Herreros, professor of Medical Humanities at the Universidad Europea in Madrid; and Santiago Delgado, manager of the Abascal legal medicine unit and director of the Master’s Course in Legal Healthcare at the Universidad Europea in Madrid. On the other hand, the ASISA Committee is made up of Dr. María Tormo, Director of Planning and Development at ASISA, Dr. Carlos Zarco, Medical Director of the Moncloa Clinic and Dr. Mariano Caballero, director of the ASISA legal department.

The Committee for Bioethics began its activities by holding the 1st Workshop on Bioethics and Human Rights this past 20th of November at the Moncloa Clinic in Madrid. With the creation of this Bioethics Committee, the Lavinia Cooperative ratifies its commitment with excellence in clinical practice and with the services provided by the firm to its co-operative members.

Photo from left to right: Santiago Delgado, Enrique de Porres, Antonia Solvas, María Tormo, Mariano Caballero and Carlos Zarco

A delegation from Tunisia's Union Nationale des Mutuelles (UNAM), led by its president Fenniche Moncef, visited Barcelona in order to find out about the healthcare model developed by the institutions making up the Espriu Foundation.

On 18 November 2008, they visited the Hospital de Barcelona, where they were welcomed by the deputy medical director of the centre, Dr. Gerard Martí, and by the director of the Espriu Foundation, Estanislau Simón. Dr. Martí gave a presentation in which he reported on the management and operations of the SCIAS co-operative, the Hospital de Barcelona and the Grup Assistència. There was a visit to the hospital's facilities after the presentation.

On 19 November, they visited the offices of the Espriu Foundation, where they were welcomed by Estanislau Simón, who informed the Tunisian delegation about the origins, mission and activities of the Espriu Foundation. There was also an information session on the Social Economy in Spain, by Lluís M. Rodà.

The UNAM was created in 1993 and includes 45 professional mutual insurance companies from the public sector and the liberal professions sector. It comprises non-profit non-governmental organisations which use the contributions made by their members to implement initiatives of a humanitarian nature and providing mutual assistance to the benefit of their members and their families. The UNAM is specifically committed to the protection of the individual, and promotes their social, cultural, family and economic development.

On 6 November, there was an information session in Hospital de Barcelona, a medical centre that belongs to the SCIAS co-operative, in response to the interest shown by Tokyo’s Institute of Nonprofit Health Care Cooperation (INHCC). Five representatives from the institute participated in the session, in order to find out about the healthcare model designed by Dr. Espriu and to study in depth the concept of co-management or shared management between the users and professionals in a system.

Dr. Gerard Martí, trustee of the Espriu Foundation and deputy medical director of the Hospital de Barcelona, welcomed the Japanese delegation and showed them the basic areas of operation of the hospital, and the organisation and management of the SCIAS co-operative. Martí also gave a detailed description of the interrelations with the professional co-operative Autogestió Sanitària. This was of particular interest to the Japanese academics due to the fact that the co-operative healthcare system in their country is based mainly on users' co-operatives.

The Espriu Foundation has become a part of the Spanish Social Business Confederation of Social Economy (CEPES) as the representative of the Spanish health care cooperatives.

Constituted in 1992, CEPES is a business confederation at national level with an intersectoral nature that makes it the largest institution representing the Social Economy in Spain, and establishing itself as a platform for institutional dialogue with the public authorities.

CEPES, as the organization that brings together the diverse existent economic activities under the concept of Social Economy, represents the interests of more than 51,500 companies. There are more than 10,700,000 individual members under the umbrella of CEPES, with more than 2,400,000 workers economically related to the sector.

The Social Economy represents a way of undertaking business in balance with the criteria for competition and competitiveness that integrates principles such as valuing the individual above capital, sharing results with collective criteria, organization with a democratic spirit, solidarity with the environment, and social cohesion.

On 13 October, a group of presidents and directors of medical co-operatives from the Brazilian state of Sao Paulo, led by Eudes Freitas Aquino, president of the Unimeds Federation of Sao Paulo, and Americo Utumi, president of the State of Sao Paulo Co-operative Organisation (OCESP) and a member of the board of the International Co-operative Alliance (ICA), participated in a day session which took place in the Hospital de Barcelona.

The vice-president of the Espriu Foundation, Dr. Josep O. Gras, opened the meeting by welcoming the members of the Brazilian co-operatives, and presented the healthcare model created by Dr. Espriu, based on co-management between users and professionals.

Afterwards, Estanislau Simón, director general of the Espriu Foundation, set out the objectives and activities of the Foundation. Mr. Simón also gave a general overview of health co-operativism in Spain and the institutions that support the foundation.

Dr. Gerard Martí, deputy medical director of Hospital de Barcelona and trustee of the Espriu Foundation, gave a presentation dealing with the concept and operation of the hospital co-operative where the session was held, and the activity and interrelations between the institutions making up the Grup Assistència.

The session ended with a fruitful debate and exchange of experiences and opinions between the doctors from Sao Paulo and the representatives of the Espriu Foundation.

Within the framework of the General Assembly of the International Cooperative Alliance (ICA) held in Singapore in October, the first meeting of the ICA Sectoral Organizations Liaison Group (SOLG) was held in which eight of the nine specialized bodies were present, including the International Health Cooperative Organization (IHCO), represented by its president, Dr. José C. Guisado.

The sectoral organizations participated intensely in the restructuring process that is being carried out by ICA, which affects both its global structure and its membership formulas and system of quotas. During the meeting, Jean-Louis Bancel, President of the International Cooperative Bank Association (ICBA), and Javier Salaberria, President of the International Organisation of Industrial, Artisanal and Service Producers' Co-operatives (CICOPA), were designated to represent the sectoral organizations and to occupy the two places reserved for them on the ICA Board.

Also planned is the creation of a group-level strategic plan based on a previously performed analysis of each organization individually. For this prior study, Dr. Guisado prepared a specific model of SWOT analysis (a methodology in which the intrinsic characteristics of a company and its position within its environment are studied with the goal of determining its weaknesses, strengths, any possible threats and opportunities) adapted to the peculiarities of the cooperative companies. During the meeting, the President of IHCO expressed his commitment to providing advice to the other members of the Group who may want it during analysis development.

A training session was held this past July 7, at the Hospital de Barcelona for participants in the biannual Johns Hopkins University International Philanthropy Fellows Conference. After a short welcoming message from Josep O. Gras, Vice-President of the Espriu Foundation, and Teresa Basurte, President of the SCIAS Cooperative, Espriu Foundation Director Estanislau Simón introduced university researchers to the health care cooperative system and described the undertakings at the Espriu Foundation.

Later, Gerard Martí, Deputy Medical Director at the hospital, offered a speech that covered four main topics: the description and function of the Hospital de Barcelona, the values and mission of the SCIAS Cooperative, which owns the facilities, the activities of the Autogestiò Sanitària Cooperative, and the services that are offered by the insurance company Assistència Sanitària. He concluded his presentation with a discussion of the practical application of the concept of co-management between users and professionals, realised in Grup Assistència.

This session was part of the activities organised for the 19th International Program at Johns Hopkins University. This event, entitled “Beyond the Welfare State: The Third Sector and the New Tendencies in Social Welfare Policy in Europe—The Case of Spain” was held in Barcelona from the 6th to the 9th of July. In reference to the situation in Spain, during the conference, which was sponsored locally by the CIES (Economic and Society Research Centre) and the University of Barcelona, the President of the IHCO (International Health Care Organization), José C. Guisado, presented on “Health Care Co-operatives in Spain.”

The Johns Hopkins Centre for Civil Society Studies is a US institution whose objective is to research and better understand the functioning of non-profit organisations in civil societies, both in the U.S. and around the world, in order to encourage the contribution of these organisations to democracy and improvements in the standard of living of citizens within democracies. The Centre is part of the Johns Hopkins Institute for Policy Studies which researches, trains and exchanges information both at the national and international level.

The Regional Minister of Health of the Government of Aragon, Luisa Mª Noeno, presided over the opening ceremony of the 8th Aula Montpellier Circuit of conferences, which took place on the 8th October, which is a reference with regards to scientific, training and educational activities in the Region of Aragon. The dean of the Faculty of Medicine, Arturo Vera, presented the inaugural conference, about the new training model according to the Bologna agreements, in which the Montpellier Clinic will participate following the signing of an agreement with the Faculty of Medicine for the under-graduate training of students.

The circuit of conferences of the Aula Montpellier will take place between November 2007 and June 2008; its objective is to create a forum of information and dissemination of current topics of scientific and medical interest, which will aid the access to continuous education and the exchange of ideas amongst the professionals of the sector, without forgetting the social and humanistic projection of medicine.

Throughout these months, prestigious specialists from the University of Zaragoza, the University of Navarra, the Miguel Servet University Hospital, the Gregorio Marañón University Hospital, the Hospital Clinic of Madrid and from the Centre for Minimal Invasive Surgery of Cáceres, will cover important topics such as the bio-ethics, glaucoma, dependence, heart insufficiency and biomedical investigation.

In the photo are, from left to right: Dr. Pérez Lamban, director of the Montpellier Clinic; Dr. García Lejarreta, representative of Asisa in Zaragoza; Luisa Mª Noeno, Regional Minister of Health and Consumer Affairs for the Government of Aragon; Arturo Vera, dean of the Faculty of Medicine and José Bueno, professor Internal Medicine.

The ASISA Bioethical Committee was constituted on July 15 in Madrid as an interdisciplinary and consultation committee from which to receive advice regarding the ethical and legal aspects of, as well as conflicts that may arise during, clinical practice. This committee will function as consultant to the various health care institutions integrated into ASISA, as well as medical professionals and institutions involved in health care related activities or training. The main functions include to advise health care professionals, directors of ASISA health care centres, and Health Science students at ASISA centres in the ethical and legal conflicts that might arise while providing health care, to analyse and propose possible alternatives and solutions to the ethical and legal conflicts as they arise, to propose internal protocols to be followed in situations which, due to their frequency or seriousness, generate ethical or legal conflicts within health care practice, to promote bioethical training in, and critical thought regarding, health care rights among both health care and non health care professionals of ASISA, in addition to students of health care.

The Bioethical Committee will be made up of experts in the field, such as Professor Santiago Delgado Bueno, from the Complutense University in Madrid, and Professors Fernando Bandres Moya and Benjamín Herreros Ruiz, both from the Europea University in Madrid. On behalf of ASISA, the Committee will include María Tormo, ASISA Planning and Development Manager, Carlos Zarco, Medical Director at Clínica Moncloa, and Mariano Caballero, Manager of the ASISA legal department.

The board of Instalaciones Asistenciales Sanitarias SCIAS has designated María Teresa Basurte as the new president of the cooperative, taking over from Josep María Reygosa. Basurte has been a member of SCIAS since 1979 and insured with Asistència Sanitària Col.legial since 1961. She has been a member of the cooperative teams since its foundation and she participated on the resource committee for four years. She has been a member of the board since 2004.

As new president of SCIAS, a cooperative that belongs to the Espriu Foundation, Basurte has joined to the board of trustees of this institution. Josep Valles has also recently taken over from Enric Josa, both also being representatives of the users cooperative. With regards to Lavinia, the cooperative of doctors which is member of the Espriu Foundation, Dr. Concepción Guerra has been appointed as member of the board of trustees.

On May 7th, Dr. Ricardo López, chairman of the Federación Argentina de Entidades Solidarias de Salud (FAESS) and member of the board of the International Health Cooperatives Organisation, visited the Clínica Moncloa, the hospital centre of reference of the ASISA group in Madrid, where he met with Alfredo Macho, managing director of the centre, and Miguel Buján, administrative manager. At the meeting they exchanged opinions and experiences regarding the management of hospital centres and compared co-operative health assistance trends in Spain and Argentina.

After, Dr. López had the chance to get to know first-hand the facilities of the centre in a tour led by the nursing manager Carmen Ibáñez, and the general director of the Espriu Foundation, Estanislau Simón.

The International Cooperative Alliance (ICA) restructuring process will bring significant consequences in the near future. With this in mind, the organisations that represent the cooperatives from a sectoral point of view, as is the case of the International Health Cooperatives Organisation (IHCO), have been working together within the Sectoral Organisations Liaison Group in order to ensure that the original vision of this process as three-dimensional (global, regional and sectoral) does indeed come true from the sectoral point of view.

On April 28th, the members of the Liaison Group, including IHCO chairman José C. Guisado, met in Brussels, in order to draft a resolution which shall be submitted to the extraordinary assembly of the ICA for its approval. The document fully supports the concept of "global membership" that the ICA board will present before the assembly, and adds two very important recommendations for the success of the restructuring process. Specifically, the sectoral organisations ask the members of the assembly to recognise the financial redistribution to the sectoral organisations as a permanent principle under the new global membership system, in the same way as it is recognised in the case of the regional organisations, guaranteeing the income during a two-year transition period where a specialised work group within the ICA board may design a different redistribution mechanism.

In addition, the sectoral resolution demands that a similar transition period be established for cooperatives whose only relationship with the ICA is through the sectoral organisation they belong to and which, under the new global membership system, would have to become direct members of ICA, which in most cases would imply a considerable increase of their membership fee and the possible risk that they would renounce membership.

On the 11th March, the president of the International Health Co-operatives Organisation (IHCO) and CEO of the Espriu Foundation, Dr. José C. Guisado, accompanied by Dr. Josep O. Gras and Estanislau Simón, vice-president and general director, respectively, of the Espriu Foundation, met in Brussels with Marc-Henry Cornély, secretary of the Belgium Organization of Cooperative Pharmacies (OPHACO).

OPHACO, an outstanding member of IHCO, is an organization that contains almost 600 co-operative pharmacies, which represent 20% of the Belgian market and provide employment to 3500 people.

During the meeting, impressions were exchanged about the current work performed by IHCO as a vertebral axis of the health care co-operatives movement, internationally, and about the possible future strategies when faced with the challenges caused by the restructuring process in the International Cooperatives Alliance.

Both the OPHACO representative and the delegation from the Espriu Foundation, agreed about the importance of the pharmaceutical sector within the framework of European health care co-operatives and are committed to carrying out combined efforts to strengthen the development and the activities of the European IHCO Committee.

On the 10th March, in Brussels, a delegation of the Espriu Foundation made up of the vice-presidents, Dr. José C. Guisado and Dr. Josep O. Gras and the director general, Estanislau Simón, interviewed Rainer Schlüter, director of Co-operatives Europe, a regional organization of the International Cooperative Alliance ICA) that groups together more than 170 cooperative organizations from 37 European countries and represents more than 160 million cooperative members.

The main aspects covered during the meeting were the future challenges caused by the restructuring process that is taking place in the ICA, in which the sectoral organizations, such as the International Health Co-operatives Organisation (IHCO) and the regional organizations, including Cooperatives Europe, are directly involved.

The representatives of the Espriu Foundation showed Schlüter their support and collaboration with the European organization and confirmed that they would attend the next General Assembly that will take place on the 28th and 29th of April.

Dr. Francisco Ivorra, president of the Espriu Foundation, ASISA and the Lavinia cooperative was awarded the XIII SCIAS Award in Seville on January 18 of this year for his support and drive in favour of co-operative health care. At the same event, the XIX Clínica Santa Isabel Award was granted to Dr. Manuel Eduardo Codes, chief of Medical Oncology at the Hospital Virgen Macarena and member of the Medical Oncology Unit at the Clínica Santa Isabel since 1984. This prestigious and traditional award within Andalusian health care circles is granted by popular vote from among the 1200 professional doctors in ASISA in Seville, who strive to identify the efforts shown by one their colleagues in this field.

The ASISA hospital—known as Clínica Santa Isabel—is one of the best equipped private hospitals in Andalusia. It is a leader in cardiothoracic surgery, haemodialysis, and oncology, amongst others, and provides coverage to 60,000 ASISA clients in the province of Seville.

On January 8 of this year, the President of the Regional Government of Valencia, Mr. Francisco Camps, accompanied by a group of ASISA representatives and managers, presided of the laying of the cornerstone for the new hospital in Elche and Crevillente which the regional government awarded to the corporation Elche-Crevillente Salud SA, integrated by Ribera Salud SA (Bancaja and CAM) and ASISA.

The construction and furnishing of the hospital translates into a 146 million euros investment and the project will be completes within 22 months, with which the new health care centre will be operating in the last quarter of 2009. The unique construction will be 44,000 square meter building, with all the necessary facilities and equipment to provide quality health care services to the 140,000 inhabitants of Elche, Crevillente, Aspe, Hondón de Las Nieves and Hondón de Los Frailes.

On November 15, 2007, some 100 persons participated in the founding meeting of the Coop santé de l’Université de Sherbrooke, coopérative de solidarité. Gathering together students, personnel and various categories of supporting members, this co-operative has the mission to unite the university community in issues of health through the commitment of university community members in promotion and prevention, key factors for maintaining a population in good health.

The health co-op will make full use of the available professional and complementary expertise including doctors, nurses, kinesiologists and psychologists. It could for example provide a health check-up, detect risk factors, and put in place strategies for better lifestyle habits regarding nutrition, physical activity, psychological health, reasonable alcohol consumption or even drug and smoking prevention measures.

In this way the health coop intends to offer programming mainly focused around the healthy living habits of its members. This sustainable orientation blends in perfectly with one of the seven major challenges that have been identified over the next ten years by the general population and scientists as part of a vast enquiry conducted by the Conseil de la science et de la technologie du Québec. On a more global scale, this commitment by the Université de Sherbrooke health coop also fits in with one of the four major priorities established by the World Health Organization: encourage good food habits and physical activity.

The board of directors of the health coop is made up of seven user members and four supporting members. IHCO board member Jean-Pierre Girard, expert-counsel in collective health enterprises, teaching assistant and researcher associated with the IRECUS, acts as advisor to this project.

More than two thousand people gathered at Barcelona's Auditorium on 1 October  2007 to celebrate the 50th birthday of Assistència Sanitària Col.legial, at an event attended by the senior management of Grup Assistència and the ASISA Group, along with doctors from Autogestió Sanitària and representatives from every field of the medical profession (universities, professional associations, unions and academics). The ceremony was hosted by the Health Minister of the Catalan Regional Government, Dr Marina Geli.

The event began with the screening of a retrospective video analysing the origins and development of Dr Espriu's social health care project which gave rise to the various bodies that today make up the ASC Group (ASC, Autogestió, SCIAS, Montepio de Previsió d’ASC, CECOEL and BIOPAT), as well as Lavinia-ASISA and the Espriu Foundation, with the active role played by the latter in the International Health Co-operatives Organisation (IHCO). With almost 200,000 users, ASC today occupies a key position within Spain's private health care sector.

The film was followed by an address from the Chairman of the ASC Group, Dr Ignacio Orce (photo), who highlighted the fact that it is doctors who have made possible the 50-year history of Autogestió-ASC, "both those who are here and those who can no longer be with us". He meanwhile thanked all those present for "forming part of a project like this, which places people before money, service before business", showing that at a time when the image of the profession is in crisis, "doctors, where there are no intermediaries, can perfectly manage their profession". He also highlighted the fact that "this organisation provides the best payments for doctors on their retirement, and is the only one which allows users to play a role. For many of them, private health care is a replacement for the public service, something which should be remembered". Dr Orce finally stressed the fact that ASC had succeeded in "maintaining its independence over half a century, something which has been far from easy, above all at certain times. Today, with an ageing population and advances in biomedicine, the challenges which face us are considerable. But thanks to you, we have 50 years of success behind us".

In her address, Health Minister Geli congratulated the ASC on its history of service and had words of praise for the figure of Dr Espriu. "This initiative has given many individuals, mostly workers, access to quality medicine which was previously the preserve of a small segment of the population," she acknowledged, while also mentioning the huge changes seen in the world of health over the last 20 years, necessitating "a wide-ranging debate as to the sustainability of the system. Everything needs to be reinterpreted. The balance struck between public and private sectors will have to be capable of providing this kind of quality medicine". Finally, she reiterated her department's support for ASC: "many people trust in you, and for that reason we will continue to stand by your side".

The event concluded with a comic show by theatre group El Tricicle, who took the opportunity to perform some of the numbers from their forthcoming work, Garrick, including a large number of gags based on the world of medicine. The spirit of community among those present was once again evident at the dinner which was served afterwards. Everyone there shared the same concern: to ensure that Assistència Sanitària Col.legial continues to play its flagship role within private, self-managed, quality healthcare for another 50 years.