A Conversation with… Dr. Carlos Zarco

Dr. Carlos Zarco is General Director of Fundación Espriu (Spain) and President of the International Health Cooperative Organization (IHCO)

Tell us about your organisation?

Fundación Espriu champions cooperative healthcare through organisations like ASISA and SCIAS, blending medical excellence with democratic governance. What makes us unique is that our members – healthcare professionals and, in some cases, patients – directly shape strategy and operations. By prioritising people over profit, we deliver care that is patient-centred, sustainable, and rooted in shared responsibility.

How does being a cooperative change the way healthcare is delivered?

It transforms the traditional healthcare dynamic. At SCIAS, for example, patients in the Hospital de Barcelona participate directly in decisions. Their input has led to real improvements, such as expanding geriatric services and launching community mental health programs. Cooperative governance means that solutions reflect human needs and every voice matters

How do health cooperatives make an impact internationally?

There are many examples. In Europe, we collaborate with national health systems to help reduce waiting lists for diagnosis, treatments, and surgeries. After the COVID-19 pandemic, when waiting times grew, health co-ops worked hard to improve patients’ access to care.

In South America, Unimed do Brasil is the largest doctors’ cooperative in the world, with 130,000 doctor members, 20 million insured patients, and nearly 300 hospitals. It has the scale of a national health service. In Africa, we are working with co-ops that provide healthcare access in communities where no other system exists. Because co-ops are owned locally, they fit with the environment and respond to real needs.

What difference does the cooperative model make for doctors and health workers?

It gives them a voice. They don’t face pressure from industry, laboratories, or shareholders. There’s no need to generate profits for stakeholders. Instead, the money stays in the system and is reinvested in two ways: better infrastructure and equipment for patients, and better earnings and working conditions for doctors and health workers. That is a fundamental difference: we work to improve services and working conditions, not just to deliver profits. We see health as a shared responsibility, and co-ops make that possible.

How is IHCO working to expand the role of health co-ops globally?

At IHCO, we are trying to bring more health cooperatives together across borders. We now have 21 members, the largest number in our history, and we are engaging through platforms like the CM50. Our aim is for health co-ops to be recognised as key partners in achieving universal health coverage. We advocate for a global framework that supports cooperative healthcare, fosters cross-border collaboration, and drives innovation.

What role does the CM50 play in advancing this agenda?

The CM50 is vital because it brings mutuals and co-ops together to share experiences and strengthen our voice. Too often, we only talk about cooperatives among ourselves. The CM50 helps us present our model to wider audiences and policymakers. It demonstrates that democratic, people-centred healthcare is not only viable but essential for resilient societies.

How do cooperatives build a better world?

By putting people at the centre. Health co-ops create inclusive systems that deliver dignity, equity, and purpose. They empower patients and professionals to co-govern, ensuring care reflects real needs. I always say that there's a third way of doing healthcare. One is the public, one is the private, and the third way is the cooperative way, which combines solidarity with medical excellence. That is how we build a fairer, more resilient, and more human world.