“We are the proof: doctors and citizens can organise themselves to provide good health systems.”


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“We are the proof: doctors and citizens can organise themselves to provide good health systems.”

Dr Orce is President of Assistència Sanitària. We meet at his office at the ASC headquarters, on Avinguda Tarradellas in Barcelona, premises that are familiar to more than two hundred thousand ASC and SCIAS members, for him to explain how this healthcare model began, and what makes it so unique in the European context.

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What was the historical context in which Dr Espriu’s model began to emerge?

A difficult context, in the 1940s, at the height of the postwar period. It was a situation during which Spain was cut off from European movements and the way society was evolving. In Spain there was a strong culture at the neighbourhood level of communities and towns organising their own affairs to deal with their health issues. In villages there were doctors who people would pay in kind if they didn’t have enough money: a chicken, a sack of potatoes or lentils, whatever. The doctor took care of the community, and the community helped to maintain him. And this concept had a name: the “iguala”.Everyone paid their “iguala” to the doctor, which was an annual amount, in money or in services or in kind. It was a very common phenomenon throughout Spain.

I understand that we are talking about the time before there was any kind of public healthcare.

Public healthcare didn’t exist back then. The doctors that there were dealt with businesses that set up services to treat the populace, with the doctors acting simply as workers, quite badly paid, and working within a strict framework that dictated the care they could offer. It was against this backdrop that in 1942 the minister Girón de Velasco laid the foundations of what was to become the National Health System. In parallel in some provinces, beginning in Vizcaya, doctors formed their own organisations, unhappy at being employed by others and receiving poor pay. They called their collective enterprise an “igualatorio”, connected with the traditional payment of “igualas”. This was a list of doctors offering medical services, with people free to choose a doctor from the list, each of whomwould be paid in accordance with the work performed.

What particular difference did the list system make compared with the traditional “igualas”?

Discover all the answers on page 38 and 38 of our Compartir magazine.

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