Health Co-Operatives a Viable Solution to the Current Crisis in Health Service Delivery

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Health Co-operatives: A Viable Solution to the CurrentCrisis in Health Service Delivery

Community involvement is vital to the co-operative model. How to involvepeople from the community is an issue faced by most co-operatives.Communities will come together against a perceived threat to their neighbourhood, but often lack the same motivation for something that is apositive addition to the community. Communities that feel disadvantagedor marginalised may want to become involved to change their situation.Interest, however, can fade and it is important, for the success of thecentre, to maintain interest and involvement over time. Communities thatbecome involved in health co-operatives will have the benefits of appropriate services, feelings of pride and empowerment, and a sense of control over their health service. - Kristen Sinats

Kristen SinatsUniversity of Victoria, British Columbia Institute for Co-operative Studies

Introduction

The Canadian media frequently reports of a “crisis” in the Canadian health caresystem. News stories have told of people waiting months, and sometimes years,for elective surgery; of cancelled life-saving procedures because of hospital bedshortages and too few nurses; of the hardships experienced by people living inrural areas when their doctors have withdrawn their services; of long waits incrowded emergency rooms; of worn-out equipment and not enough newequipment; and so on. The media has also reported on proposed solutions to theso-called crises. For example, proponents of private (for profit) health servicesclaim that allowing people the option to step to the front of the line, by paying for the service they need, can ease the burden on the public system; doctors' groupsmaintain that paying doctors more money will help solve some of the problems;nurses insist that training many more nurses is crucial to a well-functioning healthcare system; other groups contend that the whole health care system needs acomplete overhaul; and so on. In fact, CBC Newsworld’s television program,Counterspin, recently (January 30, 2001) provided the venue for a lively debateon the state of health care delivery and ideas for improvement. Media portrayalsof the state of health care were hotly contested and the participants did not agreeon health care solutions; however, everyone who spoke agreed that there is aneed for change. What the changes should be and how to implement them werefurther points of dissension. Many of those who spoke, particularly thoseopposed to 'two-tier' health delivery, argued for a marked ‘shift’ in the way healthcare is organised, practiced, and delivered. Disagreements and rhetoric aside,crisis or not, it is probably accurate to say Canadians are concerned about healthcare.

Issue

Outside of the hype of media, there is considerable evidence that our currenthealth care system, while exemplary in some areas, needs improvement inothers. What is really wrong with our health care system and how can it bechanged so that it is improved, if not fixed? Some advocates for change maintainthat the current problems range from the overuse of acute care beds to theabsence in the system of both prevention and health promotion activities. Somecritics contend that health policies, to their peril, have ignored the social andeconomic determinants of health such as poverty, education, and social support.Instead, the current emphasis on high technology, acute care, and short-termsolutions are detracting from sustainable long-term solutions that, over time,could have a significant, positive effect on our health care system. In 1996, theCommunity Health Co-operative Federation stated that “[t]he mass of provincial,national, and international health intervention outcome studies have irrefutablydemonstrated that our current individualfocused, illness based, treatmentorientated health system is both ineffective and too costly” (p. 8).

Community Health Model

There are many people in Canada who concur that changes to health deliveryservices are necessary, yet discussions of ineffectiveness and high costs haveled to few practical, long-term solutions. An exception and a promising alternativeto the status quo is the community health model. This model has provedsuccessful in a number of provinces including Saskatchewan and Quebec; itcould be considered a key strategy towards solving the ‘crisis’in health care.Many sectors of health care would benefit from one kind of community healthmodel: the health co-operative. There are many models for a health co-operatives. However, the user or client-owned model found in Canada ischaracterised in the following way:User- or client-owned health co-operatives are set up by individuals in the samecommunity to help them meet their own health care needs. Member-usersdetermine goals and practices, thereby enabling ordinary citizens to empower themselves with respect to health care. Members and owners each contributeshares of capital and subsequently contribute to operating costs, usually byprepaid premiums, and appoint managers to negotiate contracts with healthinsurance and health care providers. Often these co-operatives purchase andoperate hospitals and other facilities, and hire professional and other staff.Services range from simple preventative care and basic insurance to advancedcurative and rehabilitative interventions (International Co-operative Alliance,Website).

For example, primary-care co-operatives, as the first point of contact for healthservices, offer a range of primary health care and social services. According toMichael Rachlis (2000), primary health care is best delivered through multi-disciplinary centres, which act as vehicles for the delivery of a variety of communitybased services. Groups such as women, seniors, aboriginal persons,and people living with disabilities could be served better by a health co-operativebecause, as members and active participants in the goals of their co-op, they canhave attention paid to their special needs (Co-operatives Secretariat et al., 1999).In addition to primary care, cooperatives can be structured to provide hospitalservices and health insurance. Co-operative hospitals can be created through the joint effort of community members, concerned with maintaining hospital servicesand health professionals, employed by hospitals. There are successful examplesof these co-operative practices, such as the network of rural hospitals inWisconsin (see www.rwhc.com), and Pacific Blue Cross, a health insurance co-operative that provides insurance services at competitive rates.'Although the co-operative model has been a part of the health care sector sincethe early 1940s, never have Canadians and political leaders shown as strong adesire as in recent years to consider alternative means of providing health careservices.' (Co-operative Secretariat et al.,1999, p.17) There are examples of well-functioning models of various types of health co-operatives in Canada and the United States. Ambulance workers inQuebec have successfully formed a workers’ co-operative. Saskatchewanpharmacies are part of a co-operative data network. Saskatchewan andManitoba have primary health care co-operative centres that have been inoperation for many years. The National Co-operative Federation governs theprimary health centres in Saskatchewan.In the remainder of this paper, I describe models of primary care cooperativesand community health centres. I also discuss the strategies that are needed toincorporate these approaches within the health care system.

Background Information In Co-op/Consumer Sponsored Health CareDelivery

Effectiveness, Angus and Manga (1990) outline three models of communityparticipation in health care and how they manifest in the various centres andorganisations providing health services. The three models are the following:♦ the community participation model, which includes Community Health Centres,Co-operative Health Centres, and Quebec’s Local Community Services Centres(CLSCs);♦ the quasi-community participation model; which includes Health ServicesOrganisations, Health Maintenance Organisations, and Multi-Service Centres;and

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