Effective health care for the "poor"

"Poor" people in our minds are symbolized "grandmothers with buckwheat" or students. But this is only a stereotype. In Ukraine, as in many other countries of the world, people who are not "secured" make up the majority of the population. In health matters, it is considered that the state should care about this category of people, and what kind of treatment for them should be a free "social good". Commercial medicine, traditionally, in their business models of such people ignores, being fixated on the "income level of the average and above."

The problem lies in the fact that tens of millions of people send indiscriminately to the economically passive, "insolvent," "dependent" gray mass of "poverty". But what if you try to reconsider these stereotypes? What if you try to discern in the "poor" economically active (in their own way) the stratum of society? Perhaps the state should stop feeding the "poor" population from a spoonful of "social" health care, and businesses should stop giving this large segment of the market to the state.
I will give three reasons why it is worth trying to do this, three things that need to be changed to do this, and three ideas from which you can begin now.
In Ukraine, relatively poor people are not alone "grandmothers with buckwheat." Mathematically, the "average income level" lies far in the jungle of poverty, and the middle class in Ukraine represents a very small minority of very well-off people (by the standards of Ukraine). According to polls, their financial position as "below average" or "below security" is estimated at 90% of the residents!
What does this mean for the healthcare sector? First, the fact that in the country about 90% of people are conditional consumers of "social" and "free" medicine. Quite a lot, is not it? From the first follows "secondly": the private sector is focused solely on the remaining 10% of people - those that are considered to be "able to pay".
The situation is based on the stereotype that "poor" people are not economically active, they are not able to buy many public goods (especially expensive ones like medicine). Nevertheless, there are recent attempts to put this in doubt. The most significant and thorough of them was the article and book of the famous theoretician of business S.Prahalad "The Fortune at the Bottom of the Pyramid". It provides compelling reasons why large corporations should be understood as "doing business" with the "poor" part of the population that is the most in the world. And it is necessary to do it sooner or later.
The same idea is very relevant for Ukrainian medicine (and the economy as a whole). Both the state and the private sector should take a closer look at these 90% of people below the level of "security" and see in them the potential for more effective models of cooperation than social assistance or feed-backs for this social assistance.
Why is it worth it? Here are three main reasons:

1. With such a large number of "poor" people, no social model of health care can be organized. Even if the government wand and with its help will introduce tomorrow an insurance model, a network of family doctors and new hospitals. The system simply will not be able to generate so much money for a long time to cover all medical expenses for the "people". Many social payments can afford only a rich country. We need another way - to attract as many people as possible to finance medicine and quickly rotate money in it. To connect the category "below average" is just such an option.
2. The more the state strives to emphasize the "sociality" of medicine, the more it emphasizes the unpleasant fact: medicine deepens the gap between the rich and the poor. It is better that the medicine cut it! It is necessary to do so that people can pay as much as possible, and not so that they are more attached to the list of what they can not pay.
3. In fact, poor people can pay for medicine. Simply not so much and with not so advanced medicine. As they say, 20 kopecks - also money, and 20 hryvnia in the pocket of a therapist is also a payment of medical services. The problem is that the "poor" people pay for medicine a) in the informal sector b) in such small amounts that neither the state nor the private sector does not consider this to be a potentially important economic activity. And in vain! These "forgotten" 90% of people can and better replenish the budget, and be an interesting client for business. The question is how to organize it.

To organize this, you need to change the understanding of several important things. Here are the three most important of them:

1. It is necessary to reconsider stereotypes regarding what is a "medical product". We think that medicine is so expensive that it can only be bought by the rich, or "poorly" received by the poor. As a result, we have a situation when there are two medicine in the country. One is "social" and substandard. The second is "private" and too expensive.

The choice is reduced to several options. The category of "cheap and poor" is represented by "free" government agencies with their "what do you want?" Services. More expensive, but much better - these are average private institutions, where "privacy" is obliged to prices, and quality has not yet come. Also these are state institutions, which began to not be afraid to take money for their services. High prices and relatively high quality are offered by individual private institutions, which, as a rule, are located in the capital or large cities.

They are expensive even for the "middle class". Well, there is treatment abroad. It is interesting that this situation is not pleasant neither to people "provided", nor to people "poor". Even in their different worlds, there are advantages in terms of the price-quality ratio. This means that even "secured" people pay slightly inflated prices for the medical services they receive. There is a medical product that is affordable for "poor" people, and at the same time the quality of which they will be happy, although it is far from what is shown in American serials about physicians.

Many people consider such medical services impossible. Or maybe just no one wants to try to create them?

2. To work in the "poor" segment, you need to look a little differently at the questions of the financial result. In this segment, money is made not at the expense of value, but at the expense of volumes. And the profitability of cheap services can be even higher.

Of course, the question is how to organize such "therapist 2 consultations" for 20 hryvnia? It will not be easy to come up with such a model, but it is very useful for both the state and business. At the very least, the search for this model seems to me to be more valuable and potentially more productive than searching for ways how to make all consultations free of charge for everyone or how to raise the price to 300 UAH without losing customers.

3. You need to change and the attitude to what help you need to provide and how. Both the business and the state are now seeking ways to provide their customers with as much technological and complex assistance as possible. Both do it because it's expensive. Business is chasing the proceeds, and the state is behind the business. Both are trying each in their own way to "pull" people to the high cost of such assistance. Or maybe it's worth a little "go down" to the opportunities and needs of the market? One way is to "hit primary care for high costs." Primary care is available to everyone, there is always a demand for it and it gives good results for health.

Of course, it's easy to talk, but it is not so easy to find practical solutions for translating these ideas. However, to find a solution, they need to start looking, and this is now most important.
Here are three interesting ideas for starting such a conversation:

1. "Cheap" small private clinics. Imagine a small private clinic. The basic set of consulting and diagnostic services. Basic repairs, just to be clean, office chairs instead of leather chairs, inexpensive furniture. Used equipment, but has everything you need. Good doctors, but not superstars. So, there is no "chic", so, the equipment is not modern. But the services can be significantly cheaper and, for example, I personally will not get a crown if I go to such a clinic.
2. Private family doctors. They are free to compete and should not cover the overhead costs of the multidisciplinary clinic in which they sit. They counsel either in your home or at home, or in the state polyclinic. I suspect that 50-70 UAH. will be an excellent price for their advice. Permit yourself this can literally all.
3. Privatized state polyclinics. This is already working in Eastern Europe. The staff of the clinic privatizes the institution, becomes unprofitable and non-state. Part of the services are ordered by the state (or covered through state insurance), part - insurance, part - patients from the pocket.

Decisions will arise if you try to come up with them. The main point of this conversation is that ignoring the "poor" population, including in the form of so-called "social care", leads only to the atrophy of economic activity of this very large and very different category of people.

Conversely, their inclusion in an effective economic model solves the problems of all: saves costs for the state, increases the availability of health care, increases the number of clients for medical business, increases the economic viability of the people themselves - helps to overcome poverty.