National Health Co-op (NHC) was formed as a consumer owned co-operative in 2006 to provide affordable and accessible health care services to the West Belconnen community on the northern fringe of Canberra. Since opening its first clinic in 2010, it has grown to over 30,000 registered patients supported by 100 medical and administrative staff across ten full-time medical centres.1,2.
Before NHC, the community had difficulties accessing locally based General Practitioners (GPs); often their books were closed to new patients, involved significant waiting times or did not bulk-bill. The limited availability, accessibility and affordability meant that seeing a GP often involved travelling to other neighbourhoods, accessing non-bulk-billing doctors or more frequent visits to the local hospital emergency department. This impacted both on the financial sustainability and wellbeing of the local community, one of the most disadvantaged areas in the Australian Capital Territory (ACT).
To address these shortcomings, a group of concerned residents established the NHC, a unique model of affordable and accessible health care where the community are members of the co-operative. As a member they each have a share in NHC which entitles them to one vote at the annual general meeting3. More importantly, community members receive high quality, affordable and accessible health services in their local community. GPs receive improved working conditions, training and more rewarding relationships with their clients.
NHC is a public service mutual (co-operative) built on the principles of sustainability, equality and affordability. It is an example of a community driven solution providing a more encompassing level of health care than for-profit competitors. Research to date demonstrates that a focus on patient centred care delivers improved health outcomes due to increased accessibility to health services4, increased patient satisfaction and reduced aggregate health care spending5 and a reduction in hospital admissions6.
NHC stands as a powerful example of the ability of the public service mutual to harness the expertise and resources of both experts and the local community to tackle what otherwise seem to be entrenched and systematic failures of public service delivery. It demonstrates the importance of planning to define the problem and to ensure the mutual appropriately addresses members’ needs. Importantly, NHC has not relied on significant investment from government – indeed, one of its key lessons is for mutuals to seek diversity in capital raising. Funding from members and co-operative and mutual banks may be a more efficient way to start rather than waiting government funding.
A Public Service Mutual or co-operative is ‘an organisation which wholly or in part delivers public services through a cooperative or mutual governance structure, whereby members of the organisation are able to be involved in decision-making, and benefit from its activities, including benefits emanating from the reinvestment of surpluses5.’
In Australia we have categorised co-operatives into three main groups – consumer, producer or employee and enterprise co-operatives. They can also be a combination of all three.