World Healthcare Cooperatives: Challenges and Opportunities

According to Global Healthcare Security Index 2021, India ranked 66 out of 195 countries, indicating the need and scope for improvement. The Cooperative healthcare system which has been rendering exemplary services is yet to gain visible recognition in India. Given the need for upgrading the health infrastructure in India and providing more affordable health services to the country’s growing population, it would help appreciate the large role that cooperative healthcare can play along with others. This study explores the structure, conduct, and performance of healthcare co-operatives in India, the factors contributing to their success and failure, and the challenges they face. The Health Cooperatives have a strong presence in Kerala and Karnataka and are also coming up in other parts of the country. However, a detailed database of them for public awareness is very limited. The cooperative hospitals can meet the basic requirements of curative treatment in rural and poorly-endowed urban areas. The democratic way in which they function makes them a destination for a financially weaker section. They must retain this feature. The study covers two successful cases which reveal that India needs a more dense healthcare cooperative network. Since cooperative hospitals in tune with the spirit of service run on the principle of being ‘Not-for-Profit’ they need to be supported by the governments more liberally, without however interfering with their governance and administration.

There is a renewed interest among economists and policymakers in striking a perfect balance between the market, state, and the community for equitable and sustained development. Inclusive development is the need of the hour and healthcare cooperatives provide the perfect means to deliver that. The cooperatives can and should have an important role to play in this scenario. However, there is an important need to provide an enabling environment for the genesis and growth of Healthcare Cooperatives in India and to learn from the best models and practices across the world. The chapter discusses the effectiveness of healthcare cooperatives.

The global healthcare industry is one of the largest and fastest-growing service industries in the world. The respective benefits of public and private healthcare systems are continually debated, but a third way – that of healthcare cooperatives – is emerging as an alternative method for managing the well-being of the population. There is a growing demand for bringing together successful cases and models of healthcare cooperatives across the world. This chapter focuses on the initiatives of successful healthcare cooperative models from different parts of the world. The chapter highlights the Health cooperative’s capability to deliver positive outcomes through healthcare services that are sustained through the collaborative efforts of their members, with remarkable examples and models established in every corner of the world. Such cooperatives provide hospitals and infrastructure, medical facilities, biotechnology, information technology, and all other healthcare services. With this objective, the chapter will help to understand the initiatives in healthcare cooperatives in different parts of the world.

Providing public healthcare to people is a major challenge for governments. In this sector, public-funded systems are grossly inadequate in India, and excessive commercialization and exploitation by the private sector are a stark reality. The cooperative healthcare model is emerging as an alternate system in Kerala with its strong service objective to challenge the woes of private healthcare. The cooperative hospitals in the state worked round the clock to serve the poor and needy during the devastating COVID-19 pandemic. The pandemic has also badly exposed the weakness of our healthcare system in the wake of challenges posed by an increase in demand for health services, especially in rural areas. The resultant rise in the cost of treatment has put severe strains on the people at a time when even their day to day jobs were in peril. India has a strong cooperative movement and world-class institutions to serve as models in each sector. The Thrikkakara Municipal Co-operative Hospital, located at Cochin in the Kerala State of India on which this case study is written was established by the Hospital Society Ltd. in 1999, as a project under the People’s Planning Programme of the Government. Today, it has grown into a medium-sized healthcare establishment with the prime objective ‘Modern healthcare to all at affordable costs’ and cater to an average of 700 outpatients a day. This case study reveals the inception, development over years, facilities available, operations, management, public interface, and outlook for the hospital to become a modern healthcare institution to serve the people still better.

The foremost objective of this chapter was to present an overview of the cooperative healthcare sector in Argentina by reviewing its brief history, components and the role these healthcare cooperatives play in the society. The second objective was to look at how these cooperatives have helped women and the local communities in which they operate.

This paper has used chiefly secondary data derived from various academic papers and official and government websites which publish cooperative sector-related information. The intention was to construct a concise yet detailed study that would be of help to other researchers in the field of healthcare cooperatives since the data related to Argentina is highly scattered and frequently found not up to date.

The research has found that health cooperatives in Argentina have aided in overcoming problems in the sector such as sectoral fragmentation, negligence and frequently inadequate standards of care management as well as operational and implementation failures that the private and government healthcare players have been accused of being fraught with. Furthermore, the cooperatives have frequently played a complementary or supplementary role rather than a competitive one with the private and government players.

Through the examples presented in this chapter, it is evident that health cooperatives in Argentina are making large impacts in the healthcare domain along with positively impacting women, marginalised and vulnerable sections of the society and the community. It only remains to be seen now how far this sector will grow in the future and how many more lives will be benefitted.

The Abdur Razzaque Ansari Memorial Weavers Hospital (ARAM) came into effect on 7 April 1996, and is dedicated to the people of Jharkhand and weavers. To deal with the issues of inequity in healthcare services, ARAM was founded for the extension of affordable healthcare services to the needy in and around the area of Jharkhand. Visualised by a great social worker and legend Abdur Razzaque Ansari, it has been successfully run by his eldest son Mr Sayeed Ahmad Ansari for 28 years. This research uses mainly a case-study approach through secondary data from the hospital website and other websites citing ARAM and its functions. Consent to use data for the study was obtained from Mr. Sayeed Ahmad Ansari. Primary information was collected through the patients who availed facilities from the hospital. They were interviewed through a semi-structured questionnaire each taking 30-40 minutes. Taken over by Medanta Group on 8 July 2015 (earlier being managed by Apollo Hospitals Group for 20 years), it is the first super speciality community hospital in Eastern India. Treating over 50,000 patients yearly with state-of-the-art medical equipment and providing discounts to lower-income groups, people from the weaver’s community, freedom fighters and members of ICSI have intrigued people from these sections for affordable treatment and facilities in and near Jharkhand. With a 200 bed-capacity, nine different disciplines and 12 departments spread across the city of Ranchi, the hospital caters to a massive population at a much-subsidised rate. Reaching out to rural villages through free medical camps and awareness campaigns, the hospital showcases how a successful model of healthcare cooperative can be replicated accordingly in similar developing and underdeveloped regions.

The public healthcare system faces challenges and limitations regarding the supply and delivery of healthcare services. The private healthcare system is expensive and only affordable for some. Due to the increasing population, developing countries face a greater degree of demand–supply mismatch. The existing healthcare services in developing countries need to be more sustainable due to high out-of-pocket expenditures and low-income levels. The research design used in this chapter is a case study approach based on qualitative data. The study focuses on two objectives: (1) to have a detailed understanding of the nature of healthcare cooperatives in Spain and their contribution to meeting healthcare requirements; and (2) to make suggestions and recommendations for an improved and sustainable healthcare cooperative for developing countries. Inspired by the healthcare cooperative model of Spain and keeping in mind the ground reality of the lack of healthcare facilities and services accessible and affordable in developing countries, the authors have developed a conceptual framework with the foundation of an insurance cooperative. The Spain Model is sustainable for developing countries as it serves the interest of all income brackets, not leaving the low-income population behind. Concepts like cooperative worker insurance embedded in the model can ensure that the beneficiaries receive timely and good quality health services at an affordable price. It empowers individuals by allowing them to make small amounts of investments as premiums to secure a hopeful future for a healthy life.

Healthcare is indispensable for any civilisation to attain a good quality of life and well-being on both mental and physical levels. The healthcare domain primarily falls under pharma, medical, biotechnology, and nursing. Also, other fields may be aligned with these primary fields. Healthcare amasses the contemporary trends and knowledge of upcoming techniques to improve healthcare processes. The practitioners are primarily doctors, nurses, specialists and health professionals, hospital administrators, and health insurance.

It is a fundamental attribute needed for any society to attain good quality of life and well-being in mental and physical health. It is a fundamental right of people to receive good healthcare where drug treatment and hospitalization are available at a nominal cost, as a requirement of today’s modern era. There appears to be a significant disparity in the availability of good healthcare in rural areas compared to urban in India. Even though we enter the digital era with the facilities offered in Industry 4.0 and other advanced technologies brings about a significant change of overall processing within healthcare systems. During the pandemic of COVID-19, there has been digital transformation with success globally. Healthcare cooperatives are a new norm to support the healthcare systems globally. The chapter discusses Gampaha healthcare cooperative and reviews Ayushman Sahakar scheme in India. The reforms require time to evolve.

Human evolution has witnessed the highest level of metamorphism overages. COVID-19 alarmed us when we were unceasingly running toward monetary benefits and money, the significance of health. That initiated the thought process of improvising the health and healthcare infrastructure, leading to the birth of the health cooperative as a reform. During the state of COVID services, operations of the hospital were unreachable due to the unavailability of doctors, facilities, hiked charges, and lack of insurance coverage made people disbelieve in the system. Many social activists propose the idea of healthcare cooperatives to foster healthcare needs. The study guides us to understand the roles of healthcare cooperatives like the establishment of service facilities, modernisation of existing facilities, expansion to various topographical locations, and healthcare education to the general public, repair, and renovate the instrumentation in the medical field. The study also finds the ways and means of self-sustainability of health cooperatives with dependency on government financial support during the initial take-off. The benefits of cooperatives contributing to the NDHM and supporting the development of healthcare infrastructure in rural areas. The study enables us to find the factors that healthcare cooperatives need to consider for providing the right benefit to the citizens and factors for the self-sustained and self-resilient mode of seamless operation. The study has two different data collecting instruments, one to collect the data from the public and other from healthcare professionals. The result of the study reveals the mechanisms through which healthcare cooperatives can provide well-structured healthcare support to the nation.

Post COVID-19 crisis, healthcare has become a priority for every government. Furthermore, the pandemic has also made us realise why do we need an affordable healthcare delivery service at the grassroots level. As a result, the Government of India has come out with the Ayushman Sahakar scheme. This scheme has been launched by the Union Government with an aim to assist the cooperatives in the creation of healthcare infrastructure in this country. It is pertinent to note that the cooperatives in the last few years have transformed rural areas and have pushed them out of poverty. As a result, it will be interesting to see the impact cooperatives will have in the field of healthcare.

The authors in this work have discussed the history of healthcare cooperatives in India. After this, the authors have analysed the government schemes and legal provisions which regulate the functioning of healthcare cooperatives in this country. In the next part, the authors studied the Ayushman Sahakar scheme. The authors have discussed the features of the scheme and the impact it has generated in the field of healthcare. Lastly, the author has discussed the challenges which healthcare cooperatives face in this country and how we can overcome those challenges.