PROSALUD model : a private, non-profit organization providing primary health care for a fee

As of the second quarter of 1990, PROSALUD: had a service population of 125,000 and was still growing; was providing high-quality health care services, roughly 45% of which were preventive in nature (all preventive care is free-of- charge); and was approximately 85% self-financing, despite the fact that its prices are nearly identical to those of the Ministry of Public Health, and the fact that 8% of all care it provides is provided free to indigents. Further, the dynamics of the health sector on Santa Cruz suggest the PROSALUD"s stature and role will continue to grow. These dynamics include: PROSALUD"s provision of health care management consultant services; the intention of the Mayor"s Office to hand over to PROSALUD its seven remaining clinics; the growing public support of PROSALUD; and the interest expressed by a large subprogram of the Social Security Program in purchasing care for its members from PROSALUD. This paper describes the factors and characteristics that have contributed to PROSALUD"s success. First, the health care environment is discussed, nationally and then with specific reference to the state and city of Santa Cruz. The second section of the paper considers the general structure and operations of PROSALUD, including a detailed analysis of financial status. Topics include: the impact of the service delivery mix on PROSALUD"s net revenues; the employee incentive program; other means of controlling personnel costs; and financing innovations -- prepaid care and deferred payment plans. (Author abstract, modified)