Lokman Lutfi, Chahine Teresa
Harvard T.H. Chan School of Public Health, Boston, USA.
Yale School of Management, New Haven, USA.
BMC Health Serv Res. 2021 Mar 9;21(1):211. doi: 10.1186/s12913-021-06225-6.
Social enterprises are organizations created to address social problems that use business models to sustain themselves financially. Social enterprises can help increase access to primary health care in low resource settings. Research on social enterprises in health care have focused either on high-income countries, or on secondary and tertiary care in low- and middle-income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low- and middle-income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area.
We identify social entrepreneurs working to deliver primary health care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurship. Through in-depth interviews, we collect information on medical processes, business processes, social impact, and organizational impact according to the Battacharyya et al. framework. We then conducted qualitative analysis to identify common patterns emerging within these four categories.
Common characteristics in the business models of primary health care social enterprises include flat rate rather than differential pricing and cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under 10 years old.
Social enterprise has been demonstrated as a feasible model for providing primary health care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.
社会企业是为解决社会问题而创建的组织，它们采用商业模式实现财务上的自我维持。社会企业有助于在资源匮乏地区增加获得初级卫生保健的机会。关于医疗保健领域社会企业的研究要么集中在高收入国家，要么集中在低收入和中等收入国家的二级和三级医疗保健，这些地方常见的商业模式包括差别定价以交叉补贴低收入人群。这是第一项使用原始数据研究在低收入和中等收入国家提供初级卫生保健的社会企业的研究。目的是确定社会企业在这种环境下是否是一种可行的模式，并识别出可为该领域的社会企业家、资助者和研究人员的工作提供参考的共同模式和特征。
我们识别出在低收入和中等收入国家致力于提供初级卫生保健的社会企业家，他们已经经过致力于支持社会创业的国际组织的审查。通过深入访谈，我们根据巴塔查里亚等人的框架收集有关医疗流程、业务流程、社会影响和组织影响的信息。然后我们进行定性分析，以识别在这四个类别中出现的共同模式。
初级卫生保健社会企业商业模式的共同特征包括统一费率而非差别定价，以及跨服务而非跨患者进行交叉补贴。通过远程医疗、特许经营和移动单位，利用套餐订阅和内部信息技术系统来创收并扩大覆盖范围。在某些情况下，采用替代收入流来帮助实现收支平衡。接受访谈的社会企业中约一半是营利性的，约一半是非营利性的。大多数企业在与公共部门合作方面面临挑战。这仍然是一个新兴领域，大多数组织成立时间不到10年。
社会企业已被证明是在资源匮乏地区提供初级卫生保健的一种可行模式，其关键特征与先前在三级医疗保健中普遍研究的社会企业不同。有机会补充现有的公共卫生系统，但大多数组织在这样做时面临挑战。研究人员、政府和资助者需要更多的研究和关注，以支持社会企业家并避免出现并行系统。
