High-end Healthcare - For Good
15 January 2014 at 9:39 am
A luxury incarnation of an everyday service promises to balance healthcare in suburbs where rich and poor live side-by-side, writes journalist Nadia Boyce.
Six months ago, Melbourne’s North Yarra Community Health kicked off its experiment with social enterprise – one intended to revolutionise healthcare for a diverse demographic in the city’s inner Northern suburbs.
The Integrated Medical Centre in Fitzroy North serves the area’s wealthiest in order to support services for those struggling.
Comprehensive medical care including access to GPs, specialists, pathology and allied health is complemented by “high end” amenities – from wifi to coffee-making – to form an offering tailored to attract those who can pay upfront for services. This generates profits to be reinvested in services for neighbours in need.
Profits from the centre are expected to provide a revenue stream in coming years that will support a broad range of health services for homeless people, refugees, people with mental health issues and early intervention services aimed at children and young people.
A Concept Comes Alive
Vera Boston is the CEO of North Yarra Community Health, the community Not for Profit underpinning the new centre and other health services in the area. It’s an area which she says presents unique challenges.
“The thing about these suburbs is all have highrise public housing but are also gentrified. We have great wealth and great poverty living side by side,” she says. “We focus very much on people with high and complex needs.”
Boston was at her own private doctor when she was hit by the initial concept. While paying her bill, she was struck by the potential of that money to help the disadvantaged.
“Our ability to attract funding from traditional sources has decreased … government is very reluctant to invest in primary care as it tends to be a long-term investment and they’re likely to go for short-term solutions,” she says.
Boston notes, for example, that there is an 18-month wait for a speech pathologist, a dangerous lag in assistance for children struggling with speech issues and “a whole path on unhappiness that could be averted”.
The Integrated Medical Centre is a step towards greater financial sustainability, Boston says.
“It’s always been on our agenda to generate funds on our own. It’s not going to happen by writing submissions to government … or winning Tattslotto – we needed to make it happen,” she says.
“Someone asked, ‘why has nobody thought of this before?’ and I said, ‘I don’t know!’”
The originality of the concept paid off, with the organisation attracting the attention of two stalwarts in the Australian social enterprise space.
North Yarra Community Health was able to develop its idea with the aid and investment of social enterprise incubator The Crunch and Social Ventures Australia.
“We focused on convincing them that we had a business case that has been properly researched,” Boston says.
The difficult part, she says, was defining their use of future profits. The intent is to use funds to supplement the gaps in future, but the fluid nature of healthcare structures, programs and funding makes it impossible to predict where the greatest demand will be in years to come when funds are available.
Boston says it is quite a contrast to being able to promise more concrete and specific outcomes like other social enterprises and charities.
Above and Beyond
North Yarra Community Health runs existing community health centres intended to service those in its catchment area from socio-economic disadvantage.
“The Integrated Medical Centre started at the opposite end,” Boston says.
Targeting prospective customers has been strategic.
Added value features to encourage those able to in the community to pay the upfront fees that bulk billed primary care doesn’t require. Social impact is among these value-adds, but Boston says that while the social aspect is likely to appeal, it is not an emphasis.
“We’re not leading with it. What people want is good medical service. People won’t go to a certain GP to help someone else,” she says.
“Health is a complex issue and so many things impact on your decision to go to a health practitioner.
“Given a choice though, why not go to the one where you can help somebody else?”
Boston concedes that while promising, the initial uptake was not congruent with expectation.
“[The response] has been good but perhaps not quite as good as we’d hoped. Certainly there is growth month-on-month,” she says.
The main ongoing challenge, Boston says, is balancing supply and demand.
There needs to be enough GPs to ensure customers do not have to wait, but not too many such that the financial situation deteriorates and profit-sharing arrangements become negligible, she says.
A Growing Movement
The Integrated Medical Centre exemplifies a wave of social enterprises tackling everyday issues and providing services traditionally falling within the public sector, such as welfare, schools, transportation and healthcare.
The potential of social enterprise to deliver public services is already well recognised in the UK. The Social Value Act requires public bodies in England and Wales, including councils, to factor in the added social value created in a community when awarding contracts.
Boston says there is potential for the movement to also grow in Australia.
“There’s a whole lot of [social enterprise] services that could deliver for social services,” but, she concedes, “it’s not quite here yet.”
She speaks of a homelessness organisations in the community experimenting with similar models.
Recently community housing and support organisation Homeground Services made the media for its development of a Not for Profit real estate agency inspired by UK social tenancies where properties are listed with social housing enterprises.
Funded primarily by government to provide services to homeless people and those at risk of homelessness, Homeground Services says the agency aims to deliver more affordable housing options particularly for people on low incomes as well as developing a sustainable income model.
Boston says the model used by North Yarra Community Health is not necessarily widely applicable given it is highly localised and tailored to the demographics of the area.
“I don’t think this model is transferable across the board,” she says. “Maybe in inner city areas.
“We have unique socio-economic diversity – people living very close to each other with completely different life experiences.”
A Healthy Prospect
Currently the organisation is operating at a loss – with profit projected by 2015.
The goal for 2014, Boston says, is “not to make a bigger loss than we’ve budgeted”.
“It has kept me awake quite a few nights. It’s quite a scary thing when you are risking your own money,” she says.
The loss is expected to steadily decrease until profitability is reached sometime next year.
“These are the things we’re keeping an eye on,” she says. “We’re thinking of innovative ways to get the message out there.”
The road to financial sustainability beckons for the team at North Yarra Community Health – and Boston remains optimistic.
“We just have to be a little bit patient,” she says.