People living in small rural villages in Uganda have found a practical solution to a problem which the greatest minds and vast resources of the United States seem unable to confront, let alone solve: how to make basic health care available and affordable. There’s no national health insurance and people are quite poor by American standards (the GNI in 2006 was US$280), so they have formed health co-operatives which make regular payments to the local hospital, in return for the provision of medical care to co-op members. It’s basically a group insurance plan on a very small scale, which includes the following points: 1) pooling risk 2) agreement among members about what services will and won’t be covered.
The first point is the very basis of insurance: many people pay a small amount into a risk pool with the understanding that most of the time, they will not need the services offered; the money in the pool is there to pay for services for individuals who do need them, because no one knows when they will become sick or injured and the costs of care may be prohibitive. Of course a larger risk pool, such as the entire United States, would be preferable because the larger the pool the better risk can be absorbed, a fact our government seems not to understand. Think of it this way: is it better to spread the cost of paying for one expensive disease among 10 people, 100 people, or 100,000,000 people? Small group health plans have had to fold because of the costs of caring for one hemophiliac, for example, a problem which would not arise in a national plan.
The second point may sound heartless but is in fact only facing up to reality: if the coop tried to pay for every possible health procedure, no one could afford to be a member. This point is less applicable to the United States, because we are a very rich country, but still food for thought: if people had some awareness of the costs of, say, MRI machines which sit idle, they might reconsider whether it is money well spent.
Of course the Ugandans have several advantages we in the United States don’t have. For one thing, they have no health care bureaucracy to impose 15-20% in administrative costs on their health care. For another, they don’t have a highly-profitable industry of health insurance companies to lobby against any simple method of financing health care.
I don’t want to idealize the Ugandan experience. It is not universal care: you have to be a member of a co-op to receive treatment, and it doesn’t cover everything. And this system is not available throughout the country, only in 30 villages, and builds on the pre-existing structures of farmer’s co-ops. But there are definitely lessons in the provision of care at a reasonable cost in the Ugandan experience.
This was covered in a story on NPR, located at this link: