1. Centre for Civil Society Consumer-Centred Social Enterprise in Health Care Global Working Group Cooperatives in Health Care: Global Prospects for the Development of Cooperatives as Instruments of Consumer- Centred Health Care

2. Centre for Civil Society The global context:  Consumers, health practitioners, policy-makers and governments are searching for better models of health care  Most health systems are fragmented, illness- centred, and built around professional interests, rather than around the holistic needs of consumers  Innovators find the structures of health systems almost impossibly complex  Consumers find themselves outsiders in systems that were seemingly built to fit the needs of others.

3. Centre for Civil Society Consumer-centred health care  Policy goal in many countries  Consumer at the centre of systems  Driven by health goals: healthy living, self-care, illness prevention  One end of the spectrum: treat the patient decently  Other end of the spectrum: systems should be built around the consumers

4. Centre for Civil Society Historically …  Friendly societies: pre-paid capitation based systems, cooperative structures, local governance  Friendly society dispensaries  Bush nursing hospitals and clinics: payment by subscription, cooperative structures, local governance  Charitable hospitals: social enterprises

5. Centre for Civil Society The loss of historical memory …  Policy makers have little or no historical knowledge of past consumer-based forms of service provision  Cooperative organisations tend to have little or no historical knowledge of cooperation in health care  Social enterprise organisations have little or no historical knowledge of social enterprise in health care

6. Centre for Civil Society Cooperatives as instruments of consumer-centred health care  Locality-based primary health care  Conversions of public sector services  Consumer health plans  Cooperatives in managed care

7. Centre for Civil Society Locality-based primary health care  Usually local community-based ventures established to integrate social and primary health care. It is exemplified by the West Belconnen Health Cooperative, begun in 2010, and the South Kingsville Health Services Cooperative, begun in 1980, in Canberra and Melbourne, Australia. West South Kingsville is a self-financing cooperative of 10,000 members employing medical, dental and allied health practitioners, health educators and nurses for a pool of 30,000 consumers. http://www.westbelconnenhealth.coop/ http://www.westbelconnenhealth.coop/

8. Centre for Civil Society Conversion of public sector services Best exemplified by Your Healthcare Community Interest Company in Kingston upon Thames in the UK. It began trading as a social enterprise in 2010 after separating from the Kingston NHS. It has 607 staff providing 23 distinct services including school health and health visiting, rehabilitation, community and specialist nursing, allied health therapies, and learning disability services. It’s membership is open to staff, service users, carers and registered volunteers (Community Members), and those employed on permanent or fixed term basis (Staff Members). http://www.mutuo.co.uk/wp-content/uploads/2011/10/Community- Health-Services-Made-Mutual1.pdf http://www.mutuo.co.uk/wp-content/uploads/2011/10/Community- Health-Services-Made-Mutual1.pdf

9. Centre for Civil Society Consumers health plans Health insurance ventures created by collectives of consumers. They may be formed on a geographic basis, or by community of interest and health care philosophy (eg a Catholic health plan, a New Age health plan, a labour movement health plan). Many countries have health systems that permit collectives of consumers to establish plans of this kind, and new technology now makes it more feasible than ever before to create one. A good outline of a plan from North Dakota, USA is available here: http://conrad.senate.gov/issues/statements/healthcare/090813_co op_QA.cfm http://conrad.senate.gov/issues/statements/healthcare/090813_co op_QA.cfm

10. Centre for Civil Society Cooperatives in managed care Integrate insurance and health care. Group Health Cooperative in Seattle USA, formed in 1947, is perhaps the most well-known example. It is a consumer-governed, nonprofit health care system that coordinates care and coverage for 600,000 members. It is governed by consumers. Its 11-member Board of Trustees — all health- plan members elected by other members — work closely with management and medical staff to ensure that the organization's policies and direction put the needs of patients first. http://www.ghc.org/http://www.ghc.org/

11. Centre for Civil Society Prospects  Organisation of consumers, cooperatives and health care innovators  Consumer-Centred Social Enterprise in Health Care Global Working Group  A global agenda for development of cooperatives in health care  International Health Cooperative Organisation – mostly provider rather than consumer cooperatives in Brazil, Spain, Quebec

12. Centre for Civil Society Consumer-Centred Social Enterprise in Health Care Global Working Group Vern Hughes vern@civilsociety.org.au vern@civilsociety.org.au