Development of the Kisiizi hospital health insurance scheme: lessons learned and implications for universal health coverage

Baine, Sebastian Olikira; Kakama, Alex Ayebazibwe; Mugume, Moses

doi:10.1186/s12913-018-3266-8

“…MicroEnsure partnered with a health plan in Tanzania, covering primary health care and limited secondary care for chronic diseases, maternity, and neonatal care for a union of coffee growers for about $2 USD per month [ 30 ]. This echoes previous results from Uganda, where a non-profit hospital tested a micro-insurance scheme to provide a stable source of funding [ 31 ].…”

Section: Discussionsupporting

confidence: 85%

Business models for primary health care delivery in low- and middle-income countries: a scoping study of nine social entrepreneurs

Lokman

¹

,

Chahine

²

2021

BMC Health Serv Res

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Background Social enterprises are organizations created to address social problems that use business models to sustain themselves financially. Social enterprises can help increase access to primary health care in low resource settings. Research on social enterprises in health care have focused either on high-income countries, or on secondary and tertiary care in low- and middle-income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low- and middle-income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area. Methods We identify social entrepreneurs working to deliver primary health care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurship. Through in-depth interviews, we collect information on medical processes, business processes, social impact, and organizational impact according to the Battacharyya et al. framework. We then conducted qualitative analysis to identify common patterns emerging within these four categories. Results Common characteristics in the business models of primary health care social enterprises include flat rate rather than differential pricing and cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under 10 years old. Conclusions Social enterprise has been demonstrated as a feasible model for providing primary health care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.

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“…MicroEnsure partnered with a health plan in Tanzania, covering primary care and limited secondary care for chronic diseases, maternity, and neonatal care for a union of coffee growers for about $2 USD per month 31 . This echoes previous results from Uganda, where a non-pro t hospital tested a micro-insurance scheme to provide a stable source of funding 32 .…”

Section: Discussionsupporting

confidence: 85%

Business models for primary health care delivery in low and middle income countries: a scoping study of nine social entrepreneurs

Lokman

¹

,

Chahine

²

2020

Preprint

0

View full text Add to dashboard Cite

Background: Social enterprises are organizations created to address social problems that use business models to sustain themselves financially. Social enterprises can help increase access to primary health care in low resource settings. Research on social enterprises in health care have focused either on high-income countries, or on secondary and tertiary care in low- and middle-income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low- and middle-income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area.Methods: We identify social entrepreneurs working to deliver primary care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurship. Through in-depth interviews, we collect information on medical processes, business processes, social impact, and organizational impact according to the Battacharyya et al framework. We then conducted qualitative analysis to identify common patterns emerging within these four categories.Results: Common characteristics in the business models of primary health care social enterprises include flat rate rather than differential pricing; cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under ten years old.Conclusions: Social enterprise has been demonstrated as a feasible model for providing primary care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.

show abstract

“…This echoes previous results from Uganda, where a non-pro t hospital tested a micro-insurance scheme to provide a stable source of funding 32 .…”

Section: Discussionsupporting

confidence: 85%

Business models for primary health care delivery in low and middle income countries: a scoping study of nine social entrepreneurs

Lokman

¹

,

Chahine

²

2020

Preprint

0

View full text Add to dashboard Cite

Background: Social enterprises are organizations created to address social problems that use business models to sustain themselves financially. Social enterprises can help increase access to primary health care in low resource settings. Research on social enterprises in health care have focused either on high-income countries, or on secondary and tertiary care in low- and middle-income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low- and middle-income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area.Methods: We identify social entrepreneurs working to deliver primary care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurship. Through in-depth interviews, we collect information on medical processes, business processes, social impact, and organizational impact according to the Battacharyya et al framework. We then conducted qualitative analysis to identify common patterns emerging within these four categories.Results: Common characteristics in the business models of primary health care social enterprises include flat rate rather than differential pricing; cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under ten years old.Conclusions: Social enterprise has been demonstrated as a feasible model for providing primary care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.

show abstract

Development of the Kisiizi hospital health insurance scheme: lessons learned and implications for universal health coverage

Cited by 12 publications

References 16 publications

Business models for primary health care delivery in low- and middle-income countries: a scoping study of nine social entrepreneurs

Business models for primary health care delivery in low- and middle-income countries: a scoping study of nine social entrepreneurs

Business models for primary health care delivery in low and middle income countries: a scoping study of nine social entrepreneurs

Business models for primary health care delivery in low and middle income countries: a scoping study of nine social entrepreneurs

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