Physicians in private practice: reasons for being a social franchise member

Abstract

BackgroundEvidence is emerging on the cost-effectiveness, quality and health coverage of social franchises. But little is known about the motivations of providers to join or remain within a social franchise network, or the impact that franchise membership has on client volumes or revenue earnings.Methods(i) Uncontrolled facility based of a random sample of 230 franchise members to assess self-reported motivations; (ii) A 24 month prospective cohort study of 3 cohorts of physicians who had been in the franchise for 4 years, 2 years and new members to track monthly case load and revenue generated.ResultsThe most common reasons for joining the franchise were access to high quality and cheap drugs (96.1%) and feelings of social responsibility, (95.2%). The effects of joining the franchise on the volume of family planning services is shown in the 2009 cohort where the average monthly service volume increased from 18.5 per physician to 70.6 per physician during their first 2 years in the franchise, (p<0.01). These gains are sustained during the 3rd and 4th year of franchise membership, as the 2007 cohort reported increases of monthly average family planning service volume from 71.2 per physician to 102.8 per physician (p<0.01). The net income of cohort 2009 increased significantly (p=0.024) during their first two years in the franchise. The results for cohorts 2007 and 2005 also show a generalized trend in increasing income.ConclusionsThe findings show how franchise membership impacts the volume of franchise and non-franchised services. The increases in client volumes translated directly into increases in earnings among the franchise members, an unanticipated effect for providers who joined in order to better serve the poor. This finding has implications for the social franchise business model that relies upon subsidized medical products to reduce financial barriers for the poor. The increases in out of pocket payments for health care services that were not price controlled by the franchise is a concern. As the field of social franchises continues to mature its business models towards more sustainable and cost recovery management practices, attention should be given towards avoiding commercialization of services.

User experiences with clinical social franchising: qualitative insights from providers and clients in Ghana and Kenya

“…The results of this study support evidence from several other settings that has shown that the longer-term benefits of franchising are often elusive, and even when they do accrue, providers are more focused on the immediate, proximate, benefits of membership [ 7 - 9 ]. Training and subsidies are highly rated by providers not because they are more valued than other benefits, but because other benefits are often so difficult to discern [c.f.…”

“…Less attention has been given to provider and client experiences with or perceptions of franchising, factors that are also likely to influence the impact of this delivery model. The few studies that have addressed provider motivations to join or maintain membership in a franchise network have found that providers cite a number of factors, including access to medicines [ 7 - 9 ], social responsibility [ 7 - 9 ], technical improvement [ 7 - 10 ], improved client relationship management [ 11 ] and opportunities for networking [ 7 , 9 ]. There is limited evidence regarding the effect of franchising on service utilization [ 6 ].…”

“…However, one study found that franchised facilities experienced higher client volumes, suggesting that this could be a financial motivation for joining the network [ 4 ]. In Myanmar, franchised providers experienced increases in income [ 9 ], although another study on the same network found that finances were not a main motivation for joining the network and providers were concerned that their revenues might decline due to network limits on profit margins [ 8 ].…”

The Impact of Clinical Social Franchising on Health Services in Low- and Middle-Income Countries: A Systematic Review

“…A prospective cohort study in Myanmar showed increasing monthly client volume for family planning services for the first 4-years after joining a franchise network. Client volume also increased for child health services [32]. Another prospective study in Vietnam found franchise membership increased total client volume by 40%, and use of reproductive health services by 51% [33].…”

“…In fractional franchise networks the quality and price controls only affect the franchised services while providers can use the franchise brand name to draw customers to the full range of services offered. In Myanmar providers who joined a franchise network increased their income; largely by increasing the number of clients accessing non-franchised, and therefore non-price controlled, services [32]. Future research into the effects of franchising on the price of health services, as well as how this shapes who accesses social franchise services may enable programs to achieve greater progress towards their equity goal.…”