I’m still trying to decide how health care cooperatives work and whether they can reach the scope and scale that our health care system needs to introduce some of the reforms that are being discussed.
Last week I interviewed Steve Delfin, executive director of the National Credit Union Foundation, who told me about how credit unions work. His blog on this issue is interesting. We learned from him that cooperatives are owned and controlled by their members—the people who use the co-op’s services or buy its goods. Any surplus revenues are reinvested in the business.
Steve also recommended an interesting Web site, the National Cooperative Business Association, or NCBA. Here’s a link: http://www.ncba.coop/abcoop_health.cfm. The site has a lot of interesting information on why NCBA thinks cooperatives can work for health care delivery. On it I learned that there are about 30,000 cooperatives in all, and that they have a significant impact in four sectors of the U.S. economy: agriculture and food, credit unions, mutual insurance, and rural electric. But not health care!
NCBA reports that there are four kinds of co-ops. Every model has at least a few examples of health care services.
- consumer-owned co-ops (credit unions and rural electric co-ops)
- purchasing cooperatives (hospitals buying equipment together)
- worked owned cooperatives (there are several in home health care)
- producer cooperatives (such as Land O’Lakes)
Unfortunately, the impact of consumer-owned health cooperatives today is relatively small. The NCBA estimates that approximately 2 million Americans are member owners of consumer-owned health-care cooperatives.
The NCBA identifies some important unanswered questions that policy makers will need to address:
- Will the co-ops be seeded by government grants or will they be loans?
- How much control will the government exert?
- How much time will the government give to get health care co-ops started?
- Will the co-ops be allowed to form into a federated co-op on a national scale?
- Will there be minimum federal standards that supersede state law?
- What laws would regulate regional co-ops?
These seem like pretty difficult and complicated issues to solve. What do you think?
