Licenciatura

GuateSalud

GuateSalud ( private organization founded by Dr. Glenn Lopez.

GuateSalud delivered health care with a professionalism that had gained the respect and confidence of finca owners and workers alike. It provided a structure for the workers to learn about preventive health and to obtain treatment and medication for existing illnesses. GuateSalud also trained members of the finca workforce to act as health promoters. This strategy assured participation and communication with the people they served.

As a private organization whose funding depended on service contracts, GuateSalud remained accountable to the finca owners. The simple fact that the organization was run like a business built credibility among finca owners.

Rodolfo Martínez, an owner of a coffee finca orplantation, hired GuateSalud to manage the health care needs of his finca. Since that time, he had seen his workers' health status improve dramatically. Incidence of disease was well below the average for the region, and workers from surrounding areas were traveling to his farm and independently paying to use the health service.

Concerns About Expansion

Dr. Glenn Lopez, faces cash flow problemsand some crucial choices about how to expand his innovative health maintenance organization for agricultural workers in rural Guatemala.
Lopez felt that in order for GuateSalud to be sustainable over the long term, it would have gain a larger client base. However, he had a number of concerns about how he should go about securing new clients.

a) One concern was the political climate inGuatemala: Each interest group had its own view of private health care. These groups often resorted to violence, and political assassinations were an all-too-common way of resolving differences.

b) Another concern was GuateSalud's management capacity: The organization had focused on coffee fincas located on Guatemala's south coast. These fincas were traditional, family-owned operations that reliedon many migrant workers. In contrast, COBIGUA’s banana fincas were concentrated on Guatemala's northeast coast, and the government and social sector organizations wanted to develop the health system in the northern highlands. Both areas were extremely rural, with poor transportation and communication. In addition, the political climate in each area was very different, with the highlands beinginfluenced by guerrilla groups and the banana regions by organized labor movements. Could GuateSalud effectively manage health services in all of these areas of the country?

Finally, how did these options for expansion fit into GuateSalud's mission of providing low-cost health care to underserved populations? How did the options fit with GuateSalud's objective to be financially self-sustaining?Lopez had to be careful to keep from spreading his tight resources too thin, but he also had to think about where those resources would have the greatest impact on the underserved population's health.



The Dream of a “Peasant’s HMO” Dr. Glenn Lopez, a graduate of Cornell Medical School, came up with the idea of an international health maintenance organization for the poor during his familypractice residency.

In 1985, Lopez did a two month medical internship in Guatemala with an organization called AgroSalud, which served the health needs of finca workers, charging a fee to the finca owners. Despite the advantages of finca-based health care, AgroSalud was very small and had little interest in expanding. After he returned to the United States, Lopez resolved to start a similarprogram that would offer a sustainable, replicable model for health service provision in the developing world.

After finishing his family practice residency, Lopez moved to Los Angeles and joined the family practice staff at CIGNA Healthplans, a major HMO owned by the CIGNA Insurance Company.

Though busy with his practice of medicine, Lopez began to take steps to make his idea of a "peasant's...