Thursday, December 7, 2006

Cooperative Health and Social Enterprise

Social enterprise, mutual health, cooperative health - all flavours of health care with a socially responsible theme, usually a health care service owned by its workers providing care for local people.

Pre-NHS there were many disparate healthcare services paid for out of, often, locally arrange social insurance or worker insurance - for example a community might fund a GP with a set amount each week charged to individuals.

I have been thinking a lot about these over the past few weeks as there is a great feeling that the model of health care is a useful one - but three things worry me: accountability, ownership and accessibility.

Accountability: This applies equally to the big boys, the private / corporate sector / foundation trusts etc. To whom are they accountable and how are they held to account? What happens when things go wrong (as they inevitably will from time to time)? Is professional liability enough?

Ownership: Most recent models talk of worker ownership and profits rather that ownership by a community and the mutual interest of a community. The organisation should be there to serve the community as its primary goal, rather than its owners.

Accessibility: Pre-NHS accessibility was often assured by community ownership, i.e. if you were part of the community and had paid your duty then you had access. The NHS is a nation wide version of this. If the organisation is funded through the NHS, then there is an assumption of universal access. If the organisation is not paid for by the community as a whole then universal access is unlikely.

I think there can be a role for mutual / cooperative health care in stable communities, but that ownership should be with the community, accountability should be to the community and the whole community should have access. But then we already have this don't we?


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