Uruguay’s mutualistas: a design brief, not a fairy tale

How many “healthcare innovation” decks have you seen that never touch the actual financing model? New apps, new portals, new AI, etc. But the moment the conversation reaches who pays, for what, and when, the slides go hazy. We pour concrete on cosmetic facades while the foundations of the system remain untouched.

Meanwhile, in Uruguay, a different kind of foundation has been quietly in place for decades. People do not just buy insurance; they join a mutualista, a non-profit hospital membership. One monthly fee, standard somewhere between the equivalent of 70 and 100 USD (up to 200 USD for premium plans, older applicants and more comprehensive coverage), buys you membership in a health community, not just a contract for catastrophe. You belong to a network of clinics, hospitals and doctors. You are not just a claim waiting to happen.

Why does this matter for fitness operators, wellness apps, employers and innovators who sit at the “prevention” end of the spectrum? Because mutualistas are not just an exotic curiosity. They are a working prototype of the bridge we are missing.

At the moment, we live in two separate health cities. On one side, subscription prevention: gyms, wellness apps, wearables, meditation platforms, nutrition services, workplace wellbeing programmes. On the other, insurance intervention: hospitals, doctors, treatments, claims, codes. These two cities are connected by a rickety footpath of referrals, PDFs and reimbursement forms. Why have we accepted that the road from your smartwatch to your surgeon is essentially unpaved?

Imagine instead a proper piece of infrastructure: your personal health metro. The mutualista is the main metro line running under the city of your life. It is predictable, scheduled, and it covers the major routes from everyday care to serious interventions. Around it runs a network of feeder buses and bikes: gyms that keep you moving, wellness apps that coach you, digital tools that monitor sleep, stress and nutrition. What if those feeders were not just loosely pointing towards “health” but were structurally connected into the main line, sharing data, incentives and responsibility?

At what point does a fitness chain, or a meditation app, or an employer wellbeing programme cross the line from “nice-to-have” to de facto health system? If your members trust you with their bodies every day, if they share their heart rate, their mood, their habits, are you not already operating as part of their real health infrastructure, whether you acknowledge it or not?

Uruguay’s mutualistas offer a blueprint for what happens once you admit that reality. They encode responsibility, coverage and governance in the structure itself. Revenue is largely a stable subscription, not a chaotic mosaic of bills. So what happens to hospital incentives when income is mostly a membership fee rather than a series of unpredictable invoices? How does clinical behaviour change when “churn” is no longer just a word from the Netflix playbook, but a real strategic risk: will people renew next month, or will they move their membership (and trust) somewhere else?

If you are an insurer, could you imagine turning policyholders into members of a living system rather than numbers in a risk pool? If you are a hospital, what would it take to design a simple, clear subscription product for a defined population, instead of only billing retrospectively for activity? If you are a fitness or wellness brand, what would it mean to expand from engagement layer to risk-sharing partner, with skin in the game when things get serious?

To get there, we also need to think about the health operating system underneath. In a mutualista-inspired world, the OS is not an app, it is the membership itself: governance, funding flows, covered services, care pathways. Gyms, apps, clinics, telehealth services, diagnostics and pharmacies become applications running on that OS. Which organisations are best placed to become this health OS in your market: hospitals with deep clinical roots, insurers with financial sophistication, tech platforms with data capabilities, retailers with daily physical presence, or fitness ecosystems with intense member loyalty?

And then there is data. Continuous streams from wearables and apps could light up this health metro, showing where people are at risk long before they reach the emergency department. But how can we use that data without turning health membership into a surveillance product? Who owns the stream of signals from your wrist to your workout to your blood tests? Should members receive “data dividends” when their anonymised information improves prevention algorithms for the whole community?

Culture might be the most underestimated constraint of all. Why do people feel emotionally attached to their gym or their sports club, but rarely to their insurer? Could a hospital membership brand ever be as aspirational as a premium fitness brand? What would have to change in waiting rooms, communication, digital experience and leadership for people to say, with pride, “I belong to this health community”?

From this perspective, Uruguay’s mutualistas read less like a quirky national detail and more like a systems design brief. Membership, continuity, non-profit governance, integrated public funding, predictable costs: which of these principles could you adopt tomorrow, even inside a conventional model? Could you create SaaS-like tiers, from a basic public “line” that everyone can ride, to mutualista-style memberships, to premium longevity clubs that bundle advanced diagnostics, coaching and social support?

You do not need a national reform to start building. You can start with one neighbourhood of the future city. Picture an employer-backed urban mutualista for employees and families, blending a local clinic, telehealth, a curated gym network and mental health support under one membership. Or a national fitness chain that partners with a hospital consortium and a telehealth platform to create a “fitness-plus-care” line on the metro, where abnormal data triggers rapid clinical follow-up. Or a digital platform that does not compete with insurers and hospitals, but co-ordinates multiple mutualista-style memberships for different segments and geographies.

What if your organisation chose one of these scenarios and treated it not as a thought experiment, but as a twelve-month roadmap? What if, instead of asking whether regulators will allow it, you asked what small-scale, low-risk pilots you can already run inside today’s rules?

Here is one concrete next step you can take, starting next month rather than next decade. Choose a micro-cohort of perhaps 20 to 50 people: employees, existing customers, or gym members. For 30 days, treat them as if they were members of your own mini-mutualista. Define a single fixed membership fee, even if you only simulate it on paper. Clearly spell out what is included, such as teleconsultations, basic diagnostics, and personalised coaching. Design a simple escalation pathway so that if something serious appears, like a worrying symptom, a dangerous data pattern, everyone knows who calls whom, what happens next, and who carries the cost. Then observe. Track every touchpoint, every cost, every moment where someone feels genuinely cared for, and every moment where they feel lost.

If you actually ran this 30-day health membership prototype, what would you discover about your ability to be a health membership provider, not just a vendor, an app, or an insurer? What hidden strengths and painful gaps would it reveal? And if, after reading this, you are not willing to run even this small experiment, what does that tell you about your true ambition to help build the bridge between prevention and intervention?

💥 May this inspire you to advance healthcare beyond its current state of excellence.