july 2018
ation in accordance with his ability to attract patients. He called it Assistència Sanitària, but in essence it was simply the Barcelona Igualatorio. The formula proved a success, as over the years thousands of his medical colleagues in Barcelona signed up, creating a huge social impact. The fact is that other health insurance companies began to emerge, but Assistència’s strength crucially lay in the number of doctors signed up to its lists. By that point the Social Security system was already in operation. Why did this provision of medical insurance emerge in parallel? Social Security had problems of accessibility, and people couldn’t choose which doctor they wanted to treat them. Private companies offered greater opportunities in terms of examinations, and avoided waiting lists. The “igualatorios” were set up as a reality all across Spain, with their own service provision. Elsewhere in Europe at the same time there were insurance companies, but based on a different culture: people would take out medical insurance policies, which then refunded the cost of care. People would choose their doctor, and the policy would then refund 80% of the cost, for example. Health insurers in Europe were not set up to provide the services themselves, but rather let the market propose the medical services on offer. In Spain, meanwhile, and also in Catalonia, the “igualatorios” were born out of the idea that the doctors would themselves directly provide the service. Who devised this system of organisation by the Professional Association? When doctors decided to sign up for a list allowing people to choose, without realising it they also decided to set up a system that had never been created anywhere before: the practitioners themselves were directly providing the services, without any intermediary. And this service provision model, founded at the “igualatorios”, also spread to other insurance companies in the world of health. And so in Spain, if someone today purchases a health insurance policy, 92% of those available on the market are still policies that include service provision. This has been a far-reaching culture in Spain, which is what makes us different from the rest of Europe and the world. Abroad, traditional health insurance offers reimbursement for the cost of medical services. We are different, because although over the years all the international insurance companies have set up shop here, less than 10% of people purchase a reimbursement policy. Here, once someone has paid for a policy, they want the medical care to be organised. Would it be fair to say that the Espriu model is based on the fact that doctors not only offer healthcare, but also manage it?
“What is the role of doctors in the Espriu model? The doctor is responsible first of all for issuing the medical insurance policy, and then for organising service provision, and ultimately for directly delivering the medical service”
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