Paying for the Sick: Community-based health plans

By: Lindsay Nason

The concept of a community-based health plan marries many of my policy interests: global health, community building, and sustainable programs. I was inspired to learn more about these plans, in which the community pools its resources to provide a financial buffer for its members when they are confronted with health complications. But do the benefits outweigh the drawbacks?

Some benefits:
The program is designed around the specific needs and values of the community, making it a more valued resource than a national system. A program that is community-designed, rather than imposed by a government, will probably be more widely accepted. As it is attune to the ‘heartbeat’ of the community itself, the plan also does not have to spend money on things that are not community priorities.

One study has shown that community health plans encourage members to make use of the health services available. Perhaps when you know that your community financially supports you going to the doctor, you are more likely to go. Therefore, use of the health services they are contributing to must be integral to the success of the program itself. This type of program gives them a stake in their own health, as well as the health of the community as a whole.

Along those same lines, it would be interesting to investigate the degree to which users of community-based health plans understand that their health is important to the plan itself. If they are not healthy, they cannot work and therefore cannot contribute any income into the community plan and are probably taking resources away from the community pool.

Some drawbacks:
Community health plans leverage community assets. This may mean that they have limited resources, especially in developing countries where incomes are low. They also have limited power, as they do not represent sizable groups of people and therefore lack the power to strike a deal with providers.

Also important to note is the fact that a community-based system has the potential to at least partially subsidize health care for the poorer members of the community, but often is unable to do so because financial contributions to the plan are so central to its success and may be more than the lower income members can afford. This would be a great opportunity for government subsidization or international nonprofit funding, ensuring that these programs are able to give access to the lowest income community members.

I also wondered about the long-term success of such programs. When you are putting such resources into the hands of community members, you are generally not talking about people with professional experience in the health insurance world. This could be a blessing, in that the program is allowed to develop specifically to the needs of the community, or a curse, in that the program does not have the human capacity, vision, sustainability, or efficiency to last for generations. If the program is subsidized by the government or supported by a nonprofit organization, the community needs to make very strategic determinations in order to ensure the long-term sustainability of the community program.

An interesting point for further investigation may be to look into whether or not the community’s support of the patient effects whether or not he or she will defraud the system. Use and possible exploitation of the system would affect the long-term sustainability of the program.

Conclusion:
Do the benefits outweigh the drawbacks? It’s a challenge to say for certain, but Gottret and Schieber’s (2006) assertion that community-based health plans are better used as compliments to other programs, rather than as substitutes, seems right on target. These plans are better able to subsidize health care for the poorer parts of the community in a way that is sensitive to their needs and values, than they are to pay for health care needs in their entirety. Like so many other issues in global health, we need more and better information, but I think community-based health systems could be beneficial in the right communities. But like so many other plans, they are not going to solve the issues of paying for the sick by themselves.

Source: Gottret, P, Schieber, G. (2006) “Health financing revisited: a practitioner’s guide, Overview,” World Bank Publication, pp. 1-23.

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