The recent debates over universal healthcare in the United States have led to a focus on solutions in other countries. One example comes from Brazil, where Unimed represents the largest network of medical cooperatives in the world and is the country’s biggest private healthcare operator, with a commitment to social responsibility and meeting the needs of all sectors of the population, not just the rich.
The cooperative was founded in 1967 in the city of Santos, in the state of São Paulo, by an idealistic gynaecologist, Dr Edmundo Castilho, as an alternative to the capital-based health plans and the increasing commodification of the health system. He envisioned an alternative pathway for medical care, based on the principles of professional excellence and fairness. He joined with 22 other doctors to form the first cooperative, an innovation in Brazil at the time, the União dos Médicos de Santos (Unimed Santos).
Since then, Unimed has grown to become a network of 360 cooperatives covering over 80% of Brazil’s counties. Cooperatives have different coverage areas and are given gradings based on whether they are based within municipalities (grade one), regions or states (grade two) or the national confederation (Unimed, grade three). In addition to 100 of its own hospitals, 54 laboratories and 456 ambulances, it also has 3,033 associated hospitals within its network, and provides care to 19 million customers, 10% of the country’s population.
Unimed is structured to provide a high degree of decentralization and autonomy, with the doctors themselves responsible for the cooperative management. Every physician who joins the network must also be a partner, so Unimed’s 110,000 doctors are also the owners of the cooperatives. Every year, they provide over 69 million consultations, 2 million hospitalizations and 138 million exams.
Healthcare cooperatives can help keep the cost of prescription medicines down, help community-owned hospitals remain independent and improve the quality of healthcare. One of the initiatives to improve quality being implemented by the Unimed network is the pay-for-performance (P4P) scheme, which has been piloted by Unimed-Franca and Unimed-Belo Horizonte.
The P4P scheme gives financial incentives to healthcare providers who meet certain quality or efficiency targets, and can also include disincentives for poor performances. For example, physicians might not be reimbursed for the cost of treating medical errors. Though the jury is still out on the ultimate success of this type of scheme, it has brought higher patient satisfaction, an increase in preventive care, an average decrease in per-consultation cost and fewer hospitalizations for chronic diseases like asthma.
As in 1967, Unimed is leading the way in providing quality, affordable healthcare to the Brazilian people.