MAY 2018

GLOBAL
Health co-operatives are on the rise, IHCO report finds
A new report by the International Health
Co-operative Organisation (IHCO) has
found that the sector has grown in
importance over the past 20-30 years. The
research, which looks at co-operatives
from 13 different countries, concludes the
growth is clear reaction to the increased
demand for health services coupled
with the rising difficulties faced by
public authorities to support expanding
healthcare expenditures.
Co-operatives’ ‘distinct approach
Co-operatives have a distinct approach
which enables the development of
prevention services and improving
wellbeing, it says.
In Canada and Italy, for example,
co-ops are targeting the needs of elderly
populations, while in France health
mutuals are becoming increasingly
relevant in collective care.
All healthcare systems examined
presented similar challenges, such as
demand for long-term care services due to
longer life expectancy, the difficulties of
most health systems to organise preventive
care; long wait times for healthcare; and
the general problem of containing rising
health costs.
According to the report, these problems
lead to further implications, including
growing inequalities between groups of
individuals in urban and rural areas, the
increasing cost of private coverage, more
pressure on healthcare workers to boost
their productivity, and a gap between
demand for personalised services and
standard healthcare provision.
A co-operative solution
The paper argues the potential of health
co-ops has been underestimated, due
to privatisation of health care service
delivery favouring for profit providers,
and health co-ops being disregarded by
policy makers. One of the reasons for this
is the assumption that private providers
have higher efficiency than non-profits
and co-ops. The lack of reliable data on
the relevance of non-profit and co-op
health organisations is another barrier.
The research showed that the most
popular type of health co-ops are worker
co-operatives and mutual aid societies.
Worker co-ops can bring together different
professionals operating in different areas
of the health sector: doctors, dentists,
nurses, pharmacists and paramedics.
This model is particularly widespread in
Brazil and Argentina. In Belgium, mutual
societies play the most central role in the
national health system, with 99% of the
population covered by mutual protections,
the sole provider of compulsory
health insurance.
p Brazil’s Unimed is one of the world’s biggest health co-ops
Pharmaceutical co-operatives are
another type of producer co-operative that
is common in Belgium, Spain and Italy. In
Canada the ambulance sector is managed
directly by worker-members rather than
by traditional non profits.
Another finding was that rather than
competing with other providers, health
co-ops tend to fill in gaps left by these.
The benefits of co-operation
The report notes that like any type of
co-operative, health care co-operatives
are formed and operated not to maximise
profit for investors, but rather to address
the needs of specific stakeholder groups
or the community at large.
This means co-operatives can be set
up specifically to increase accessibility
of health services to poor stakeholders
and marginal or peripheral communities,
contributing to reducing health
inequalities. Furthermore, by promoting
decentralisation of power, co-operatives
enable increased flexibility in the supply
of health care services.
The participatory dimension of
co-operatives has several beneficial
impacts: it encourages the adoption of
prevention strategies to fight against
health risk factors at the local level, and
it enhances the relational dimension
of health services, thus contributing to
improving their quality.
The research shows that contrary to
expectations, co-operatives succeed
in funding their activities like or even
better than for-profit providers using
alternative modalities, including the
subscription of shares by large groups of
users and the accumulation of profits in
special reserves.
Co-ops can attract additional resources
such as voluntary work and donations or
price discrimination policies in different
areas. The contribution of volunteers
is particularly important in Italy and
Canada, says the report.
In terms of innovation, the paper found
that health co-ops have a tendency to
innovate when it comes to organisational
structures and services.
IHCO president Carlos Zarco said: “One
of the main conclusions of the study is that
health co-operatives have great ability to
adapt to new socio-economic contexts as
they have demonstrated over years their
suitability when it comes to solving new
needs in the health sector.”
MAY 2018 | 17