Health+Care

=Introduction to Social Entrepreneurship in the Field of Health Care:= = = Health care is a very complex issue. Without adequate health care, people all around the world are at risk from diseases ranging from life threatening to easily cured. Poverty plays a huge role in tackling these obstacles in medicine. Often times, poor people do not have access to the same quality of health care that wealthy people do. Social entrepreneurship has been providing many successful solutions to alleviating health care problems, resulting from poverty. The allocation of health care resources and finding effective health care operations are at the top of worldwide concerns relating to medicine. The discrepancy between quality and affordability is also a concern. We will examine two case studies that present unique solutions to these problems.

Lack of a U.S. Case Study:
We had difficulty finding an example of social entrepreneurship in the United States. The examples we found were large companies attempting to innovate in some way, but they have a larger business model to support them. There were also several colleges that were conducting studies in the field of health care, but those colleges were supported mainly by public funding and private donations. Neither of these had a sustainable profit model focused toward innovations like traditional social entrepreneurs. = = = = = = toc = Case Study #1: Grameen Kaylan =

**Background:**
In 1983, a Nobel Prize winning economist by the name of Muhammad Yunus started a microcredit and community development bank in Bangladesh named the Grameen Bank. The business gives out small loans to poor individuals and families in order to help them start up very small businesses. This practice is formally known as microfinance. Microfinance has been overwhelmingly successful in alleviating poverty and improving the distribution of health care services to the very underdeveloped country of Bangladesh. After the first ten years of Grameen Bank, 58 percent of the borrowers had lifted themselves out of poverty compared to 18 percent of non-borrowers (MICROCAPITAL STORY). Now, the business has assets of over $855 million, allowing the company to greatly expand to include a cell phone company, an energy company, a fishery, and a clinic network. According to Yunus, these projects are known as “social businesses” ("Small loans, big results"). This case study will focus one these social businesses in particular, Grameen Kaylan.



Case Study:
In 1996, Grameen Health created various clinics around Bangladesh under a program known as Grameen Kaylan. The main problems with Bangladesh’s health care system are the inefficient distribution of health care and inefficient health care financing operations. Grameen Kaylan health care centers tackles both of these obstacles. Each clinic provides emergency services, pharmaceutical laboratories, and camps for community health outreach. The average clinic has the ability to serve a population of 50,000 people that live within about a ten kilometer radius of its location. Currently, the Grameen Kaylan program has expanded to 48 clinics throughout the country. Each clinic provides very affordable health care to the people of Bangladesh so long as they are covered under the Grameen’s Health insurance program. The insurance program provides full medical insurance for the price of about $2 a year per family (Grameen Health). Grameen Health is working with General Electric (GE) to provide inexpensive and accessible medical devices to these various clinics ("Small loans, big results"). In future years, Grameen Kaylan will continue to strive to expand and make great strides in improving the status quo of health in Bangladesh.

Critique:
Despite the seemingly good intentions of this social business, Grameen Kaylan has experienced some scrutiny. In 2005, CGAP (Consultivative Group to Assist the Poor) conducted a case study of the social business, finding promising results: “Grameen Kalyan has been able to meet its operating expenses fully from the revenue from cardholders and investments for the past three years. Grameen Kalyan’s experience shows that with an injection of a large endowment fund for a limited period, and with sound investment management, it is possible to reach financial viability” (Hograth). However, Mathew Jowett of the World Health Organization is very critical of the organization: “This in itself is a major achievement – generating a profit, however, would be far more problematic.” He claims the success of Grameen Kalyan in creating a nearly self-financing Health Microinsurance scheme to “covering only small risks, that is, low-cost care in primary clinics, having low operating costs, for example labor, and achieving scale in terms of membership” (Hograth). Also, the intentions of Grameen Kaylan have been scrutinized as accusations have been made about the idea of business in medicine. According to Keat Yang of the McGill Student Network for Economic Development, “It is one thing to look at privatization of public goods in askance, but there is a distinction between social enterprises and firms that seek to maximize only profit” (Shyba). The Grameen Bank does profit from Grameen Kaylan, but according the organization’s mandate, all of the excess money must be reinvested back into the business and the community.

References:
1. Hograth, Ryan. “MICROCAPITAL STORY: Grameen Kaylan offers Health Microinsurance for USD 1.73 Per Year and Partners with Pfizer Inc, GE Health care, and Mayo Clinic. Is it Economically Viable? (Part I of IV).” MicroCapital.org. April 22, 2009. [].


 * Annotation: ** This article by "MicroCapital" is a case study of Grameen Kaylan. "MicroCapital" conducts various case studies related to mircoinsurance.

2. “Sustainable Healthcare for All” Grameen Healthcare Trust. [].


 * Annotation:** This is the main website by Grameen Health that provides background information about Grameen Kaylan.

3. Shyba, Peter. “Small loans, big results” The McGill Daily. Sept. 30, 2010. []


 * Annotation:** This article summarizes various microcredit projects conducted by Muhammad Yonus, including Grameen Kaylan. Also, it provides some criticisms that have been raised with regards to Yonus' works.

=**Case Study #2: LifeSpring Maternity Hospitals**=

Origin:
LifeSpring is a for-profit company that operates low-cost maternity hospitals for low-income women in India. Their first hospital opened in 2005 in Moula Ali, India (LifeSpring Hospitals Website). It became profitable after just two years of operation. LifeSpring is a joint venture between HLL Lifecare Limited and the Acumen Fund. HLL Lifecare Limited is a healthcare company owned by India’s Ministry of Health and Family Welfare. The Acumen Fund is a U.S. based nonprofit group that funds social businesses throughout the world (LifeSpring Hospitals Website). LifeSpring is a perfect example of the merging of sectors in social entrepreneurship. A government owned company and a nonprofit group combined to create a for-profit social business.

Problem:
LifeSpring addresses a huge problem in India. Thousands of women die every year in India due to pregnancy and childbirth. Many of these deaths could be avoided if proper prenatal and other types of care were provided. However, poverty prevents many women from getting medical care in India’s more traditional private hospitals. This problem is solved due to the low costs that LifeSpring offers. The cost of a normal delivery is only $80 US, and the cost of a doctor’s consultation is $1.75 US. These prices are around 30% to 50% below normal market rates for private Indian hospitals (LifeSpring Maternity Hospitals.pdf). The focus on maternal care and high volume of births allow LifeSpring to keep costs low.

Private vs. Public:
In addition to the problem posed by unaffordable private hospitals, LifeSpring also combats the problem of free public hospitals. While India does have some free public hospitals, the quality of care is often diminished. The large number of patients with a wide array of illnesses overtaxes the public clinics (LifeSpring Hospitals Website). LifeSpring provides an alternative to both the expensive private hospitals and the free public ones. Instead being forced to make a choice between affordability and quality, Indian women can have both.

Sustainability:
Women who come to a LifeSpring hospital are customers paying for a service, not people looking for a handout or charity. Because of their for-profit model, LifeSpring is sustainable, and as of 2010 has opened 9 hospitals in India and has given birth to 5,800 healthy babies (LifeSpring Maternity Hospitals.pdf). LifeSpring hopes to expand in India over the coming years and looks forward to providing quality and affordable health care to low income Indian women in the future.

References:
1. "High Quality and Affordable Maternal Health Care." //Affordable Health Innovations Global Initiative//. World Health Care Congress, 2010. Web. 18 Oct 2010. .

Annotation: This is a website giving a brief summary of LifeSpring.

2. "LifeSpring Maternity Hospital." LifeSpring, 2010. Web. 18 Oct 2010. 

Annotation: This is a pdf file giving a more detailed explanation of LifeSpring's mission statement and accomplishments.

3. "LifeSpring Hospitals." LifeSpring, 2009. Web. 18 Oct 2010. .

Annotation: This is the official website of LifeSpring. It has detailed information on the origin, mission, and other facts about the company.