The Atlantic reported last month about an unconventional aid organization in Pakistan that appears to be overcoming some of the barriers to traditional aid programs:
So while USAID is very good at quickly mobilizing assistance to disaster-afflicted communities, it carries a lot of political baggage — so much so in places like Pakistan that the U.S might be better off in the long run by downsizing USAID’s direct activities there and working through alternative programs.
One good model might be the Rural Support Programmes Network. A sprawling collection of local NGOs, the RSPN was founded by the Agha Khan Network in 1982, and has since become its own, separate program. While the stats about its reach are impressive — reaching millions of the poorest homes across a vast swath of Pakistan — what’s especially fascinating about RSPN are its methods.
Put simply, RSPN has a different focus than normal aid programs. They emphasize the development of institutions first, and only after that institution is established do they worry about its output or performance. The NGO also heavily invests in the smallest scale of the community, from conceptualization to execution, hiring mostly locals to administer projects. Lastly, they have extraordinarily long project timelines — sometimes as long as 15 years from start to finish.
RSPN’s activities might be of interest to readers of this blog because they run a significant health microinsurance program:
But the most interesting project RSPN has done in rural Pakistan is a collaborative micro-healthcare insurance system. For very little money — $3.50 a year in some cases — poor people can get access to basic medical care (especially maternity care) and assistance if they face hospitalization.
We’ve previously provided a view of healthcare in the Netherlands. Now here’s another new development—the possibility of a unique approach to home healthcare called SOS Doctors, modeled after a similar program in France. Roeleke Uildriks and Ji Kwen Ng offer perspective:
Q: You briefed us before about the recently revised Dutch healthcare system. Lately, you’ve been working on a new care provider proposal that would create added value to the system. Tell us about it.
Uildriks: The concept is called SOS Doctors, and it is borrowed from a successful program in France, SOS Médecins. Arnold Verhoeven, a Dutch citizen who now lives in France, learned that there, one can call for a doctor to visit at home, anytime, 24/7. He wants to improve the quality of care here, and he is convinced this would be an important improvement. We were asked to analyze the financial impact an initiative like this would have on healthcare costs, and present it to government and physician representatives.
Q: How do the government and the healthcare system in the Netherlands view this idea?
Uildriks: They are concerned a service like this will raise healthcare costs, because people will be calling all the time. And, of course, utilization will increase.
Ng: Physicians are worried, too. The National Association of General Practitioners (GPs) is worried about the quality of care, because they claim that the SOS Doctor will not have a personal relationship with the patient or have access to the patient’s record. Of course, when a person goes to the emergency room the specialist does not know the patient or have the patient’s records, either.
The head of the White House Office of Healthcare Reform stoked some controversy this week by suggesting that a Medicare-like model is not the only way to go when it comes to a public healthcare option:
There are different breeds of public plans that could be part of this.”
The response from many organizations has been negative. Still, there are certainly other models. Before the Medicare-like public plan idea gained steam, an FEHBP-type plan was often mentioned. Then there is the Healthy American Act.
Not to mention ideas from overseas. The Dutch system has drawn a lot of attention; see the interview below for more information on that.
A wholesale change seems less likely than something incremental, but perhaps there are things to learn from other countries. Either way, it is simply too early to handicap this race.
For profit, for everyone: Exploring the Dutch healthcare system
The Dutch healthcare system is the world’s only private system of basic healthcare insurance operated by insurance companies for profit. We asked Dutch healthcare actuaries Roeleke Uildriks and Ji Kwen Ng to explain.