«Health demands solidarity, and we cooperatives know all about that»

Coomeva, a Colombian cooperative enterprise group with close on 250,000 members, is the country’s largest solidarity-based grouping of professionals. The company’s Executive President Alfredo Arana explains the keys to its successful management.

For those unfamiliar with Coomeva, what is its main activity?

Coomeva is a Colombian cooperative enterprise group made up of 17 companies with more than 3,000,000 affiliates and 15,000 direct employees in 24 regions of the country. The parent organisation and majority owner of the group’s companies is Coomeva Cooperativa, founded in 1964 by a group of 27 doctors in response to their need for health provision and pensions.

The cooperative brings together professionals from all disciplines. It provides them with mutual solidarity and protection services, and also offers exceedingly comprehensive opportunities and solutions for education, housing, entrepreneurship and business development, travel and tourism, leisure and culture.

The other companies of the Coomeva group provide their members and other customers with financial savings, credit and investment services, through Bancoomeva and Fiducoomeva, protection and insurance with Coomeva Insurance Brokers, and both mandatory and voluntary health insurance, the latter being provided by our company Coomeva Medicina Prepagada. We pioneered this service in Colombia in 1975, and remain the population’s first choice, while also establishing an international profile.

What are the main challenges faced by the Coomeva co-operative group?

One permanent challenge we face as a group is to ensure that our goals with regard to our members and cooperative focus are not skewed by business activity. We have achieved that over our 54 years in operation, and mean to continue that way. And so our first challenge is the issue of focusing on the issues and principles of cooperative association. Ensuring that we satisfy our members in their roles as users, managers and owners, thereby expanding the social base.

Another major challenge is connected with breaking into the digital economy and ensuring that the organisation is ready for the fourth industrial revolution. Our aim is to generate 20% of the group’s revenues via virtual channels over the coming years, but at the same time ensuring that we don’t lose touch with our members, and that areas for face-to-face contact remain in place.

We are developing really strongly in this regard, as demonstrated by the http://www.aboutti.com platform, which is a great opportunity for Colombia. It is a business model based on the medical tourism marketplace of our enterprise Coomeva Medicina Prepagada, which aims to encourage patients from abroad to come to Colombia for their health treatment. On 30 October 2018, in fact, it received the Healthcare Revolution Innovation Award, an accolade given to the most mould-breaking and innovative enterprises in terms of their service and business models in the sector.

Internationalisation is another challenge. Together with our strategic partner in the United States, Christus Health, we continuously look into various opportunities for involvement in the health and insurance sectors in countries such as Mexico and Chile.

Of course the major challenge right now is our voluntary health insurance company, which in financial terms has been affected by the liquidity crisis in the Colombian healthcare system.

How has Coomeva helped build the Colombian health system?

Ever since it was founded, Coomeva has managed to generate solutions to the social security problems of its members, and one of our most important contributions has to do with the institutional aspect. For example, Coomeva brought the voluntary health insurance model to Colombia and played a pioneering role with its prepaid medicine company, which has been in operation for more than 40 years now.

With this voluntary insurance experience and the responsibility of being a co-operative set up by doctors and with considerable membership in the health sector, Coomeva answered the national government’s call in 1995 to support mandatory health insurance for the Colombian population, by setting up the health promotion body Coomeva EPS. Within its first few years, it established itself as the second-largest such EPS body in Colombia.

With Coomeva Medicina Prepagada we provide more than 2,500,000 services per year throughout the country, including more than 500,000 medical and specialist appointments and over 1,500,000 diagnostic and laboratory tests.

Through the mandatory insurance provided by Coomeva EPS we offer provision in 111 municipalities around the country, with insurance for more than 25 million services per year, including nearly 1.5 million ER treatments, over 70,000 surgical procedures, 33,000 deliveries and 183,000 hospital admissions, while maintaining our goal of caring for the health of the Colombian population.

We undoubtedly help to extend provision by delivering the necessary resources for the health system now to cover 97.2% of Colombians, nearly 22.4 million on a subsidised basis, and 21.7 million through a contributions system.

The ageing population and increase in healthcare expenditure are issues that threaten health systems throughout the world. What do you think co-operatives can offer in this regard?

Health is a public good that can’t be provided sim-ply by the individual response of the State, the market or civil society. Health is a social construct, and so needs to be underpinned by solidarity, and cooperation in order to function. And we co-operatives know all about that.

The Colombian health system is based, among other principles, on universality, subsidiarity, solidarity, equality and fairness, sustainability and transparency. Principles that fully coincide with those of the co-operative enterprise model.

For nearly 200 years co-operatives have shown that these principles do function, and work to offer synergistic results that are greater than the sum of their parts. Social and communal participation is fundamental in the management of both the health system and co-operative enterprises in order to achieve their goals.

As regards the particular aspects of health expenditure and the challenge of an ageing population, as co-operatives we provide a response in many cases where the State does not, or we at least complement State provision. Specifically in health expenditure, we have promoted and implemented service models based on promotion and prevention and the networked integration of services. We are also aware of the need to incorporate administrative technology to increase efficiency in our services.

The contribution made by cooperation in economic spheres regarding adult life and retirement is one area where as co-operatives we need to show we can do more, as the impact is huge. We help bridge the pensions gap, which is increasingly proving to be one of the greatest challenges of Social Security systems. We are one limb of the system, providing economic support with the benefits that we offer members through the co-operative’s social and solidarity funds.

You have spent much of your career in the cooperative world. What key aspects would you say mark the difference between a commercial and a cooperative enterprise?

I would highlight first of all that you have to understand and believe in the cooperative model, in other words, to identify with the cooperative’s goals. Goals that focus on essentially humanistic criteria, their main purpose being the well-being of individuals.

Cooperatives need to understand the expectations not of a small group of shareholders but a whole community, represented first of all by the members and their families, acting in accordance with criteria of efficiency and sustainability.

Another priority aspect common to cooperative management is the balance that has to be maintained between social and business aspects, in that one could assert that both are essential in order for the cooperative to function.

There can be no doubt that another highly significant element in cooperative management is that the design and functionality are based on sound models of corporate governance, as a factor that allows decisions to be taken in accordance with technical criteria, transparent interests, appropriateness, and ultimately clear accountability.

In the case of the Coomeva cooperative group, the enterprises are created out of their members’ needs. Not as an end in themselves, then, but rather as a means to achieve the higher goals of collective well-being, based at all times on sound processes of planning and strategic execution.