High-quality Medical Services for People with Low Incomes

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High-quality Medical Services for People with Low Incomes

Costa Rica
Project Summary
Elevator Pitch

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Our mission is to offer specialized and high quality medical services to people with scarce economic ressources from both rural and urban areas. These services that benefit thousands of patients every month are: Optometric consultations, ophthalmology, general medicine, gynecology, audiology, otorhinolaryngology, clinical laboratory, dentistry, ocular and auditory surgery, glasses, contact lenses, and hearing aids. In this way, we present the opportunity to low-income populations to improve their quality of life, giving them the chance to access medical services at a cost 70% less than in the private sector with first class specialists and cutting edge technology. This program has a very large coverage, due to the fact that a patient with an illness does not have to worry about monetary expenditures. Sometimes ASEMBIS even attends to patients free of charge, of course, with a previous social-economical study that determines the capacity of contribution of the patient and his family.

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Your idea
Focus of activity

Healthcare Delivery

Start Year

September 9, 1991

Positioning in the mosaic of solutions
Main barrier addressed

Limited reach of healthcare infrastructure

Main principle addressed

Adopt market-based models as a scaling-up strategy

Innovation
Description of health product/service offering:

Our mission is to offer specialized and high quality medical services to people with scarce economic ressources from both rural and urban areas. These services that benefit thousands of patients every month are: Optometric consultations, ophthalmology, general medicine, gynecology, audiology, otorhinolaryngology, clinical laboratory, dentistry, ocular and auditory surgery, glasses, contact lenses, and hearing aids. In this way, we present the opportunity to low-income populations to improve their quality of life, giving them the chance to access medical services at a cost 70% less than in the private sector with first class specialists and cutting edge technology. This program has a very large coverage, due to the fact that a patient with an illness does not have to worry about monetary expenditures. Sometimes ASEMBIS even attends to patients free of charge, of course, with a previous social-economical study that determines the capacity of contribution of the patient and his family.

Description of innovation:

This program is innovative in the way it is based on high volumes to create a low cost. This allows us to maintain financial sustainability in the project. There are no similar health programs in Costa Rica, which means that our program is a completely new service. The way that we obtain the volume is by getting to the patient focusing on the prevention of illnesses such as blindness and deafness. In this way, people can learn not just about the organization, but they can be more informed about diagnosis and possible treatments that are offered without economic factors playing a predominate role in the change of the quality of life that the population needs. The innovative idea consists in seeking out the patients in their own homes through health promoters and campaigns, which helps to reach both rural and urban communities, targeting the stratum of the population. Moreover, prices are accessible to those who are in need which provides a high quality service through the use of cutting-edge technology and adequate infrastructure. Exonerating some patients from the payment of services when they meet the requirements, has turned into an effective solution for the economic situation of our patients.

Operational model:

There are six fully-equipped medical clinics that are structured to reach different geographical regions of the country. This allows us to service remote areas through health promoters. We promote attention through health agreements that are directed at the working class that in the majority of cases, have the capacity to pay for health services provided at both personal and family level. This has allowed us to increase our level of attention to other patients that require our services.

Human resources:

The team behind this initiative fully shapes its work, including each of the 163 contributors that work in the six clinics. Their work includes maintaining clean, pleasant and healthy locations for the patients and going to remote communities with the mission of informing and detecting our population?s health problems earlier. The health contributors are academics and professionals, however it is also fundamental to prove their attitude. This is our approach for two reasons: First, the correct attitude increases an efficiency in their daily work through energy and positivity. The other reason is that a good attitude provides the confidence for better customer service and creates an atmosphere that encourages recommendations for improvement. A good attitude of an employee creates responsibility, loyalty, honesty and generosity ? values necessary to work in organizations with social visions like ours.

Key operational partnerships:

Partnerships must be related to services and training ? Christoffel Blindenmissi?n Internacional (donations, training, conferences) ? World Vision (Donation of medicines) ? IIMAS Instituto Mixto de Ayuda Social, donations ? Caja Costarricense del Seguro Social (services) ? Asesa (manages the odontology area of ASEMBIS). ? We do not have members other than voluntary associates on the directive board. In actual fact partnerships in our countries face difficulties when signing contracts with ASEMBIS from medical guilds: there is normally opposition from medical professionals who feel that their interests are being affected. The fact is that they have not analyzed the patients that we attend to who would not be potential patients to their surgeries/medical centers. On an international level, we still enjoy great success in the coordination and advice to other groups interested in replicating this concept.

Impact
Financial Sustainability:

<ul><li class="entry-label">Fees charged to clients?: <span class="entry-text">Yes</span></li><li class="entry-label">How do you assure affordability?: <span class="entry-text">Generally the patients pay for the services, but there are diverse mechanisms used to ensure that all patients can use the services including: accessible prices for people with scarce resources, a social work program that evaluates the capacity for family payment, a program that awards up to 100% in subsidies, the possibility of financing through credit companies, and constant promotional and discount programs. </span></li><li class="entry-label">Earned incomes as a percentage of operating costs: <span class="entry-text">95%</span></li><li class="entry-label">Other funding sources: <span class="entry-text">Our budget is 95% composed of resources contributed by patients and 5% from monetary or in-kind donations including technical training, medicine or equipment received from different organizations. </span></li><li class="entry-label">Strategy for long-term sustainability: <span class="entry-text">We are able to have a scale of accessible prices because of the high number of people who come to our clinics. The interesting aspect is that those who are able to pay for the services indirectly help those who are not able to pay. ASEMBIS has been financially self-sustainable for the last 10 years. This has been possible through constant revisions of our costs and prices, a market study every six months, consideration of inflation and minimum wages. The strategy is based on maintaining a detailed control of the levels of market prices and inputs and understanding the competition in order to maintain the lowest possible prices. We are trying to expand vertically to push us to become our own suppliers through the purchase of specialized machinery. </span></li></ul>

Current and Future Impact:

<ul><li class="entry-label">Total number of clients: <span class="entry-text">+ 1,000,000 </span></li><li class="entry-label">Clients in the past year: <span class="entry-text">330,000</span></li><li class="entry-label">Percentage of low-income clients: <span class="entry-text">26%</span></li><li class="entry-label">Impact: <span class="entry-text">Through our example, we have managed to disprove the paradigm of ?cheap becomes expensive?. </span></li><li class="entry-label">Overall "market": <span class="entry-text">In Costa Rica, there is a state social security system, but every day their services are even more deficient which consequently increases the demand for different health services. This phenomenon is not only visible in Costa Rica but the whole of Latin America. ASEMBIS is an exportable model to all of Latin America and I would put forward that it is globally viable as well.</span></li></ul>

Scaling up strategy:
Stage of the initiative:

<i>Scaling Up</i> stage.

Expansion plan:

Up to now, Asembis has control over all the branches. Work capital is necessary to open a clinic, but since attending the Pyramid Business Opportunities conference in Mexico, I would consider franchises as an option as they would allow for a faster scale up and would allow for people to succeed through their own businesses while perpetuating Asembis at the same time. We have never worked with franchises so one restraint would be our inexperience in this field, but with advisors and consultants we can get this project into shape.

Origin of the initiative:

The initiative began under the leadership of Rebeca Villalobos Vargas to improve the quality of life of people without having a lack of money posing a problem. Rebeca Villalobos Vargas, Costa Rican, was born in San Jos? on the August 11, 1961. She now resides in Guadalupe. She started her training in the field of human solidarity in the decade of 1981 to 1991 with the Asociaci?n de Caravanas de Buena Voluntad (Association of Good Will Caravans) where she worked as a coordinator for the Caravan?s ophthalmology department and as a supervisor of the Infant Centers and the clinic of medical specialities. Already, she dreamed of an institution where money would not be a limit to give highly technical medical services. In 1986, she studied the administration of social projects in The School for International Training in Vermont and was part of the Scholarship Program for Peace.

Sustainability
Policy change:

To increase the opportunity for credit with banks or financial programs that will allow the increase in the capacity of medical services. These continue to be a social and health necessity in this country and require an immediate solution.