Moving Beyond Charity: How CURE is changing how low-income patients perceive health care
CURE, the charity-based group of hospitals perhaps best known for its innovative treatment of hydrocephalus (see related article), might soon also be recognized for its seamless shift to a more sustainable model.
That’s the goal of Derek Johnson, who has served since June as CURE’s director for development and sustainability, after many years as the executive director of CURE Uganda. In a recent interview with NextBillion in Ann Arbor, Mich., Johnson said CURE, which was founded in 1998, has “identified a need to look at how we function as a business and to be able to become more efficient. We’re looking at how to be more sustainable.”
The U.S.-based nonprofit includes 10 hospitals in emerging economies around the world, including six in Africa. “We have probably reached a scale that we can appropriately resource and fund and we’re not necessarily looking to grow it,” Johnson said, adding that the organization wants to retain “an entrepreneurial, opportunistic” mindset.
One such opportunity resulted from an innovation that Dr. Benjamin Warf pioneered at CURE Uganda, where there was a huge group of untreated pediatric hydrocephalus (water on the brain) cases. Hydrocephalus is traditionally treated by placing a shunt from the brain to the abdomen. The initial surgery usually works, but the shunts fail. According to Johnson, half fail in first two years, almost all within 10 years. That requires more surgeries and hospital visits. Uganda lacks the access to care that is common in developed countries, Johnson said, so a shunt “introduces a liability” for patients in Uganda.
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Forced to find an alternative, Warf came up with a procedure to cauterize part of the fleshy membrane inside the brain that produces cerebrospinal fluid. Called ETV/CPC, the technique is successful for 70 percent of babies younger than 1, typically requires no further surgeries and is cheaper than a shunt for the families involved. It is so successful, in fact, that the low-resource CURE hospital in Uganda has trained 28 surgeons from 16 countries on ETV/CPC. Twelve pediatric neurosurgeons from the U.S. have visited, Johnson said, and a doctor in Tennessee is now doing as many ETV/CPC procedures as shunts.
The training has become a source for new money. “We are receiving funding for (the hydrocephalus surgical training program) from the private sector in the United States and it is something that we work hard to be able to package and deliver to a donor community. And I think it’s attractive to a lot of folks. We’re building capacity and offering a novel new treatment for the most common pediatric brain condition in the world.”
It’s all part, Johnson said, of finding revenue models so CURE can help more children. It started in earnest eight years ago, when CURE began requiring contributions for patient care – even if it was only $10 per family. “We wanted to make sure that whatever their situation was, we were going to take care of their children, but we also wanted them to conduct a transaction with us, to take ownership of that child’s care,” Johnson said. “So what started as an enterprise to create ownership of health care for that child has turned into a new sustainability model for us.”
At first, the hospital in Uganda collected maybe $1,000 in fees per month. Last year, those fees totaled $125,000 from basically the same population, Johnson said. “We’ve actually realized a lot more income through patient contributions without losing our patients,” Johnson said. “We’ve actually increased the volumes, the quality of care is consistent, and where our patients are coming from is the same as they were 10 years ago; primarily from rural areas of the country, from lower-income families and from a lot of young mothers bringing their babies.”
In fact, the hospital’s volume increased dramatically since starting to charge fees in 2007: surgeries almost doubled, from 750 to 1,300, and outpatients went from 3,000 to more than 5,000. “In the beginning, when we introduced this model, there was some push-back and it wasn’t always easy,” Johnson said. “But we were trying to change from being a charity-based hospital to creating a more sustainable hospital that was offering a valuable service.”
Now, he says, “the culture has changed in how they perceive health care.”
For more about CURE’s history and its drive toward self-sufficiency, see the video below:
Kyle Poplin is the editor of NextBillion Health Care.
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