“Health management is increasingly distant from doctors”
You don’t trade with health
Dr. Orce is the son of the culture of effort at a time when young people did not have sabbatical years: if you don’t want to study, work! At 14, he entered Health Care as a bellboy and ended up being the dolphin of the founder of that health insurance company created and managed by doctors, and of the Espriu Foundation, which, over the years, exported the model to the whole world, especially to most nations that lack the Western welfare state. Embedded in that environment of doctors from whom he likes to learn, he soon returned to his studies and graduated. For his part, Dr. Espriu saw in that young trade unionist the drive that healthcare needed and passed the baton to him: “I have never stopped being an activist, a non-conformist… There is much to improve in this world, don’t you think? And with health you cannot speculate or trade ”.
What did you do doctor?
The experience of knowing during the years of my adolescence the life of the psychiatric sanatorium of Sant Boi del Llobregat, which in its day was of the order of San Juan de Dios. My uncle lived there, he was a friar.
And what were you doing there?
I went every weekend. I lived with all kinds of people, doctors and patients. I was impressed and decided to become a psychiatrist to help the sick.
What kind of student was he?
Bad, I didn’t find meaning in what we were studying, I had never seen an adult do a break. I stopped studying at the age of 14 and started working as a bellboy in Health Care.
I had the gift of people, I got off on the right foot, made friends, and soon became an administrator. At the age of 17 I thought that I could get my colleagues to have a better quality of life by joining the union.
Was he a union clerk?
Yes, from the vertical union. I organized a strike in 1971 that the entire staff seconded to the astonishment of the management, Franco was still alive.
Did they punish you?
Doctor Espriu decided to monitor me closely. When I was already in my second year of Medicine, one day he told me that he was going to set up a table for me in his office.
Second of Medicine?
I finally understood the meaning of studying. He worked in a medical company and wanted to be like them. I resumed in the fourth year of high school and did not go down from notable until I finished my degree.
What did you learn from Espriu?
He had an extraordinary baggage of culture, tolerance, capacity for dialogue and respect for the opinion of others. I have never seen anyone so respectful. A school of life.
We did what we called the traffic light. At the end of work we would stop at the Rosselló traffic light with Balmes and we would talk for ten minutes. He had great ideas, and I had all the energy.
What did they ride?
As in Health Care, Espriu considered that doctors in the rest of Spain should also have their own identity instead of being in the hands of mutuals. He took his Seat 600 and went to promote the idea in Spain, which was well received, and gave me the opportunity to participate in it.
We know that healthcare is big business.
Health insurance companies are designed to make money, but in Spain, and especially in Catalonia, they were born from the tremendous associative fabric. People came together to solve common problems such as health, and small mutuals flourished.
In the rest of the world people buy a policy.
Yes, and they compensate you a certain percentage, they are reimbursement companies. Here people are used to paying a certain amount per month and when they need something they give it to them.
Are doctors the victims of health insurance companies?
It is possible to sell insurance policies at the prices that are sold because the great sacrifice is the doctor, who is very poorly paid. There are places in Spain that still charge seven and nine euros per visit.
There is such a huge asymmetry between what the medical professional offers and what is perceived to be embarrassing. In a medical company like ours, profit to capital is prohibited, what is sought is the best possible remuneration for medical acts and freedom to practice the profession.
What does the Espriu Foundation do?
Teaching how to fish, transferring the cooperative solution to an international scale. More and more countries adopt it. From Malaysia to Venezuela, in Africa, South America, Asia.
What is the problem of public health in Spain?
A chronic underfinancing that survives thanks to waiting lists. In Catalonia alone, 5,000 million euros more per year would be needed to be able to meet real demand. What is luck?
You will say.
That almost three out of four citizens have a mutual health. And the other problem is that the management of health care is increasingly removed from doctors, condemned to a secondary role, it is bureaucratized. Doctors have to regain medical leadership.
And the users?
They must have a relevant role and not be someone at the end of a process.
What have you not forgotten about the sanatorium?
I made friends with a boy with Down syndrome, he knew he was going to die soon, because then they lived for about thirty years. He died in the prime of life. A psychiatrist told me that with the evolution of medicine they would live much longer; for me that was a lever.