Armed with a five-year, $750,000 grant from the U.S. Agency for International Development, Land O’ Lakes aproached HealthPartners in 1997 to help dairy cooperatives in rural Uganda establish sustainable, prepaid health care delivery programs…

We’ve also helped these local leaders learn to develop a benefit structure appropriate to the level of members’ contributions. Through the collection of dues — an average premium is about $1.98 per month for a family of four — members receive the health care benefits that they decide as a group to buy. Sixty percent of the group must participate in the scheme to ensure a strong base and avoid adverse selection…

The group-decision process helps members determine the price of the prepayment scheme. Through this process, the extent of benefits is determined for each group. For example, some groups support hospital maternity stays, while others view delivery as something that can occur at home…

In Uganda, providers frequently are not paid for their services. For example, Ugandans often leave the hospital in the middle of the night to avoid payment or register under false names so their family members can simply slip away if the person dies. By creating a system where providers have a stronger assurance of being reimbursed, our work has supported the addition of a new hospital maternity wing and two new clinics to serve prepayment members. And we’ve helped to organize the Uganda Community-Based Health Finance Association, composed of the 12 prepayment programs in Uganda. This is a voluntary association for sharing information and experiences to improve outcomes of care.

Here is the full article from Managed Care Magazine

To learn more about how HealthPartners decided on a prepayment system in Uganda, read an excerpt from George C. Halvorson’s “Health Care Co-ops in Uganda: Effectively Launching Micro Health Groups in African Villages“.

I’m not advocating this system blindly as a possibility in the United States. The real reason it works, in my opinoin, is that the cooperatives are relatively small and made up of people who already work together and depend on each other in other facets of their lives through the already existing dairy cooperatives. What I do like about it, is that it reduces beurocracy through prepayment and it also allows for more customization within each cooperative. There is no attempt to make a one-size-fits-all for an umanageably large population, like say the population in most U.S. health plans. Each cooperative does work to achieve a one-size-fits-all solution, but everyone’s voice is much louder.

In Uganda, the level of cooperation needed to achieve such a structure is possible, in no small part, to the fact that they all appreciate the ability to have health coverage. They don’t see it as a privilege, they see it as something they collectively work for, for the betterment of their communities. They all depend on each other so having everyone healthy is not only a moral decision, but one that benefits the collective as a whole. The caregivers also benefit because they no longer have to be at odds with their patients, their community, over money vs. life and death decisions. They can treat without wondering where the money will come from while also knowing that their patients have a vested interest in their own health and the health of others.

In the Uniter States, it’s harder to see our dependence on those around us. There are people living just feet away that it is possible for each of us to never see. If they were there or not, we generally see no effect upon our lives. We can also be in two places 40 miles apart each day and think none of it, while in Uganda, they do not have that luxury. They have to make their communities work because they really cannot survive without them. Americans, on the other hand, have been able to construct a society where community is a nice-to-have, not a necessity, and without that necessity, there is little incentive for any of us independently minded people to participate in such a community based plan.

Our independence is the cornerstone of our nation, and its a major reason why we could not work collectively by choice. We have to be forced into a collective solution that none of us really have a say in because our say would most likey contain the word “me”.

I am considering this Ugandan solution a bright spot, regardless of any comparisons to the United States. My real joy in this situation is that health care, in whatever form, has been made equitably available to Ugandans. And I’m glad that it is an idea that is different from what we do here because what we do here isn’t necessarily what is needed somewhere else. I think that is always something to keep in mind.