The price of good health

Several years ago, while working with an indigenous Guatemalan community to improve health access, a pregnant woman experiencing severe convulsions arrived at the local clinic. Fatima was close to full term, and had two young children by her side. But her convulsions were already out of control. She died shortly after arriving.

Fatima suffered from untreated preeclampsia, pregnancy-related high blood pressure. Despite experiencing headaches, some nausea and swollen hands, she had not sought medical help. Lack of health information, inconvenience, and the inability to pay for care pushed her to wait for delivery to see a doctor, and it killed her.

As a physician who has now spent 21 years working with poor communities in developing countries, this situation is all too familiar.

Even in countries such as Guatemala that offer free access to public health facilities, the services offered rarely cover the full cost of care. And the resulting direct and indirect costs of seeking medical attention are often prohibitive. This was a big part of Fatima’s dilemma. Although she had made the decision to give birth at the public hospital, she could not afford the costs associated with going to all the prenatal visits.

To save lives and improve health we urgently need health financing mechanisms that help people cover the out-of-pocket medical costs they inevitably incur. We cannot wait for truly universal health care to be the status quo. Too many lives would be lost in the interim. And, even absent a health catastrophe such as preclampsia, poor health and untreated conditions present a major challenge for women and men working hard to overcome poverty. Innovative health financing that complements public efforts provides one crucial solution to this crisis.

Demand meets supply

Given that the majority of the world’s poor must pay out of pocket for crucial health care services and products, Grameen Foundation has focused on developing solutions that ease this financial burden and that connect people to the information, services, and health products they need when they need them.

Health information and health financing services are core components for improved health access. These two activities not only directly benefit the poor, but also lead to the generation of more rational and reliable demand for health services.  This, in turn, allows health care providers to invest and respond with a healthcare supply that can meet consumers’ needs.

Our solutions take different forms. For example:

• In Benin, we work with a network of women’s savings groups, bringing their members services that integrate health and nutrition education, health financing, and linkages to health providers. Our initial goal was to reach 3,000 savings group members and their families. Today, over 15,000 members have access to health through negotiated benefits with 43 public and private health providers.  The groups also set up dedicated health savings accounts and disburse microloans to group members so that they can afford health services when needed.
• In Ecuador, we worked with a cooperative, Cooprogreso, to incorporate electronic payment services for health into Cooprogreso’s existing consumer credit card. The service connects cardholders to local health care providers and helps to cover healthcare costs. Within three years, 586 health access points in urban and rural areas that have previously only accepted cash transactions have been integrated into the system, enabling cardholders to access clinics, hospitals, dentists, ophthalmologists, and three different pharmaceutical chains.
• Partners in the Philippines and Ecuador now offer hospital cash microinsurance. It provides a daily payment to enrolled members when they access inpatient services. The innovative approach brought together microfinance institutions and insurance companies to develop health financing that could serve poor and low-income clients, mostly women and by extension their families. The per diem payments can be used to help cover direct or indirect costs of care, in both public and private facilities.

All of this work incorporates three key elements: 1) Improving health literacy for consumers; 2) designing financial products and services that are appropriate for meeting specific needs of local people; and 3) establishing partnerships between the financial and health sectors, including both public and private health providers.

Whether you believe that healthcare should be free for all and paid by taxes or made accessible through market-based solutions, there is no debate that health care costs are a real burden, particularly for poorer households.

At Grameen Foundation, we believe there is no one solution when it comes to designing health financing and services that can close the gaps in the system. In the coming months, we look forward to sharing more of our practical experiences and lessons learned about health education, health financing, and the role the financial services sector can play in improving health outcomes.

Dr. Gabriela Salvador is Senior Director, Health, for Grameen Foundation.