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more specialized medical cases. This also has the
effect of driving people with less critical illnesses
to rely on the community healthcare workers and
focus on more serious medical conditions. With
this operating model, the central medical facility
may subsidize the charge of the patients in the
remote locations to encourage the usage of the
local services provided by community healthcare
workers. The increase in charge for the outpatient
attending the facility directly will have to offset
the cross-subsidy to the remote patients in order
to ensure self-sustainability.
Yet a further alternative revenue model is to
fund the system through a micro-health-insurance
arrangement. Such as concept is not new and has
been proposed before (Dror & Jacqueir, 2001).
This micro-health-insurance scheme may be run
by the central medical facility or its affiliate, third
party micro-insurance provider in order to ensure
that there is a sufficiently large subscription base
to support the operation. People in the rural com-
munity can be invited to subscribe to the micro-
health-insurance in exchange for low or no cost
healthcare by the community healthcare workers.
The money raised through the insurance scheme
will be used to fund the community healthcare
workers and the central medical facility.
day. Dividing the workload among the three com-
munity healthcare workers each will have a case
load of attending to about of 27 transactions each
working day. For a 10 hour shift, each patient will
have a transaction time about 20 minutes, which
may include the commuting time by the commu-
nity healthcare worker if it is an out-reach family
visit. We may assume that the time is reasonable
as most of the illness probably would be routine
or minor comparatively.
Also in our example, we assume each month the
central medical facility will handle 80x30 = 2,400
transactions. Over the same period, each commu-
nity healthcare worker will handle about 27x30 =
810 transactions. For each transaction a patient is
assumed to be charged $1, the total revenue for
sharing between the healthcare workers and the
central medical facility amounts to $2,400. If the
healthcare worker take 60% of the revenue, the
monthly income for each worker is 2400x0.6/3 =
$480 or $16 per day. The central medical facility
will have a monthly-revenue of $960.
For locations where people generally live on
less than $2 a day, charging $1 for seeing a com-
munity healthcare worker could be a heavy burden.
If the patient fee is reduced, it will weaken the
income for both the community healthcare work-
ers and the central medical facility. Some kind of
local business approach has to be implemented
to make the case sustainable.
One way is to overlay the system with a micro-
health-insurance scheme so that people can pay
a subscription on a long-term basis to cover the
healthcare cost. In other words, for a “free” ser-
vice without co-payment, the cost of $2,400 has
to be equally shared by the 8,000 inhabitants in
the community. This amounts to each paying $0.3
per month as a contribution to the micro-health-
insurance scheme.
In the above example we have not built in
additional enhancement to the basic system such
as incentive scheme and sliding base pay scale
for the community healthcare workers to drive
loyalty and combat fraud. The intention is to keep
9.1. A Simplified Case Example
In order to put the discussion of the solution's
feasibility into perspective, it is instructive to
dimension an example healthcare system to il-
lustrate the overall principle quantitatively. In our
example, we make an assumption three community
healthcare workers per central medical facility and
that the central medical facility has an addressable
patient base of 8000 inhabitants. In other words,
the ratio of central medical facility to community
healthcare worker to addressable inhabitants is
1:3:8000, respectively.
If we assume 1% of the addressable patient
base is not feeling well on a daily basis, there will
be an average of 80 patients using the system per
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