B. Jointly Owned Health Primary Cooperatives

 -------------------------------------------------------------
   This document has been made available in electronic format
      by the International Co-operative Alliance ICA
 -------------------------------------------------------------

                   Advance Unedited Version

----------------------------------------------------------------
  REVIEW OF NATIONAL EXPERIENCE IN PROMOTING AND SUPPORTING
   THE CONTRIBUTION OF CO-OPERATIVES TO SOCIAL DEVELOPMENT:
 
  CO-OPERATIVE ENTERPRISE IN THE HEALTH AND SOCIAL CARE SECTORS
      A GLOBAL REVIEW AND PROPOSALS FOR POLICY COORDINATION
----------------------------------------------------------------


CHAPTER II.    

B.   JOINTLY OWNED (USER-AND PROVIDER-OWNED) HEALTH PRIMARY CO-
     OPERATIVES [TYPE 1.1.2]

Health co-operatives of this type are known to exist only in
Costa Rica and Spain.  In Costa Rica, the health co-operative
"Coopesana" was founded in May 1993 in the canton of Santa Ana,
15 kilometres west of San Jose, and served a population of
27,000. 

In January 1995 it had 67 members, including both doctors and 13
community associations (individuals could be members only through
their associations).  Each paid identical shares (equivalent to
226 Canadian dollars in 1995).  

In Spain a jointly-owned primary level co-operative hospital, the
"Sociedad Cooperativa de Instalaciones Asistenciales Sanitarias
(SCIAS)", operates in Barcelona in close association with a
complex of provider-owned health co-operative organizations,
which provided most of the capital for its establishment.  This
is a true joint service provider- and user-owned co-operative:
members include health professionals, support personnel and
patients (persons holding a "policy" with the Asistencia
Sanitaria Colegial/Autogestio Sanitaria).   Transformation of an
existing incomplete building (originally intended as a Hilton
Hotel) began in 1983 and was completed in 1989.44/