Interview with Dr. Enrique Porres
Interview with Dr. Enrique Porres
Dr Enrique de Porres is Espriu Foundation Trustee and Secretary, and Asisa CEO. In this interview, he explains his views on the implications of cooperativism in the medical profession and the future challenges of health cooperatives.
What motivations or spurs drove you towards co-operative healthcare?
I suppose its consistency with the principles and values that prompted me to study Medicine. Ever since I began my studies, my only “militancy” has been within the context of my profession. Firstly, focused on achieving appropriate training so as to be able to engage in free and responsible professional practice; as a representative of my faculty peers, aiming to demand the best possible training, and later as an active member of the independent professional medical union, helping to improve contractual conditions in the sphere of paid employment. Until ultimately I became involved in the co-operative health movement founded by Dr Espriu, that from my personal perspective represents the organisational and enterprise vision in healthcare that offers the fullest approach, and that best aligned with the values that should characterise the vocation to serve seen in a profession like ours.
What has it meant to you to practise professionally at an enterprise based on co-operative principles?
Essentially, the opportunity to achieve most of the aims that always marked my personal vision of how professionals should work, what the limits should be on their independence, and how one can best facilitate responsible practice as regards their patients.
In my view it is far from easy to serve as a health professional without a strong vocational component, given the emotional demands that the personal relationship brings into the act of delivering care, and the economic imperatives that can ultimately intervene in our decisions. Nor is it easy to attempt to do so in isolation from others. Service in healthcare provides a platform where different disciplines merge, and in order to be effective today that requires a multidisciplinary approach on many occasions.
It is an activity that entails an ability for teamwork, characterised in that it involves people whose capacities are limited by illness, increasing their sensitivity as to such personal aspects as embarrassment or the need to establish a truly trusting relationship, in which a warm and even tender approach can come about. And also with the required confidentiality. All these aspects are undermined by organisational rigidity, the dehumanisation that characterises excessive bureaucracy and the individual insensitivity that may accompany a legitimate desire for profit that any purely commercial activity will involve, features that to a greater or lesser extent are present in most of the formulae employed to structure healthcare systems.
At a co-operative enterprise it is all quite different: the mission is the essential consequence of championing principles based on a positive concept that the voluntary implementation of group solidarity for the development of any activity is always better than the obstinacy of an individualist approach. Its aims are, then, social. It does not have a commercial vision. The basis is to guarantee that its members can fulfil their capacities to the utmost.
How are these aims pursued in practice? Because a co-operative is after all still a business…
At a health co-operative, a doctors’ co-operative like ours, without any political or financial intermediaries intervening in the relationship between us and those who need to receive our care, all efforts are focused on the development of two fundamental institutional commitments: first, to guarantee that the care received by the people who call for our services corresponds to the criteria of the latest medical science, and fulfils the demands of medical ethics. And secondly, to demand that the performance of healthcare practice guarantees that professionals can act with independent judgement and access to adequate diagnostic and treatment resources in order to provide an effective response with the means available to us.
Clearly, as at any enterprise, the obligations go beyond that, and require management to perform strategic analysis, to understand the market, operational plans, compliance with standards, organisational demands, etc. But behind all this there is one fundamental difference that characterises a co-operative’s values: once the targets for each year have been fulfilled, any operating profit becomes an instrument for solidarity, is reinvested in the business. Because there is no capital demanding a return. Co-operatives do not pay out dividends. The profit is dedicated to improving the capacity of the co-operative itself and providing access to the development of more and better activity for its members.
Do you believe these values can motivate new generations?
I am absolutely sure of it. Despite the media influence of certain mass television channels, presenting patterns of extreme individualism based on social success at any price, I believe that among the youth of today the values of solidarity and personal commitment are increasingly evident. There are countless examples of association movements based on solidarity, focused on resolving or helping to overcome a huge range of social needs, both here and in other countries. And over recent decades they have multiplied as a result of the depth of the crisis triggered by the speculative rampage of the financial sector, which has not yet been overcome.
The motivation to join a particular co-operative, though, may not arise spontaneously because there are certain negative connotations that need to be overcome.
What specifically are you referring to?
Co-operatives, being a business, have also suffered from the contamination that the behaviour of a significant part of the business world has conveyed, with the reductions applied to their workforces during the economic crisis. There have been so many and such notorious examples of this that the ripples they have caused have undermined the voice of the social economy as a sector, which unlike what has happened in the sphere of capitalist enterprise, has addressed the downturn in economic activity while attempting to preserve jobs. However, this effort has not yet achieved the stature required to provide proof of how co-operative principles are different.
Meanwhile, there is a long-standing prejudice that links co-operative enterprise with sectors of low technological innovation or association movements created to delay the closure of companies in crisis, with little future viability. These are unjust cliches, that we need to overcome by improving the communication emerging from the co-operative movement. Because the experience of co-operatives, in terms of the volume of economic activity, is still recent, and has not yet achieved sufficient critical mass to outweigh the media power of the big lobbies of capital companies. Hence the need to intensify efforts in the sphere of social information, communication and collaboration with association movements focused on championing the general interest in any sector of activity.
What approach do you think will be needed to guarantee the survival of the care model that the co-operative health system represents?
In my opinion, there are two operational approaches that need to be clearly distinguished in order to be effective. In terms of the actions of our co-operative itself, namely healthcare delivered through the insurance operations that make it possible, we need to maintain the course that has brought us this far, and to publicise it to new generations of health professionals, because an example is always the overriding value of any bid for leadership. And the example of what has been achieved through efforts committed to the administration of shared interests in the development of the professional practice of so many is something that can be seen and measured.
After a journey lasting forty years, two million people trust in our approach. 15 hospitals and clinics and more than 50 enterprises (providing diagnosis, specialist treatment, technological operational support, etc.) generated by the effort to rationalise administration, to make it more efficient every year, reinvesting every euro earned through this to improve our service capacity: those are our credentials. And to convey that reality is the obligation on those of us who are still working today.
The second facet is less specific, but even more necessary: to give a greater momentum to the co-operative movement. As with any activity with an ideological component, the co-operative movement needs to grow and strengthen, to gain ground and drive so as successfully to promote its values, to alter the inertia of today’s society. It needs to achieve a position of social leadership, beyond its economic volume, and underpin its active presence in all initiatives focused on involvement in championing the values that should characterise free and democratic societies. Because it is there that we find the ideal culture in which to sow the seeds of its philosophy, namely the aim to generate economic enterprise models in all sectors intended to satisfy social needs, developing objectives through a vision the purpose of which is not profit for profit’s sake, but the continuous improvement of the society on which we focus our daily efforts.