During the International Year of Co-operatives, which just ended, we made a presentation to the Special Committee on Co-operatives on the issues and specific characteristics of the Canadian co-operative movement.
We would like to bring your attention to the following recommendations. First, spur the development of new health care co-operatives by building partnership agreements with local health care networks and by offering start-up financial support. Second, clarify the rules regarding annual contributions made by members of health care co-operatives. Third, acknowledge the investment made by members of health care co-operatives by allowing them to claim their contributions as medical expenses. Fourth, promote the development of new health care co-operatives in order to create new drivers of innovation adapted to the specific needs of communities. And lastly, set up a committee to study the opportunities for complementarity between the heath care co-operative model and the development of health service offerings in Canada.
The following supports our recommendations.
The Canadian health care system has some undeniable strengths, including access to a variety of basic services for all citizens. Some serious dysfunctions must nevertheless be acknowledged. Co-operatives arise out of the desire of a group of individuals to meet a collective social, economic or cultural need. They pool their resources and skills to achieve it. They equip themselves with means and expertise they would not have had access to without the co-operative. They follow the co-operative principles of democracy—one member, one vote—financial participation, autonomy, intercooperation and engagement in their community. When we talk about the principle of accessibility, we are referring to the Canada Health Act.
The health care co-operatives concept is both simple and innovative: a community identifies common health care access needs or new health service requirements. Next, it establishes a co-operative offering free or competitively priced facilities, equipment, technological tools and administrative services to health professionals and/or physicians. They tag on complementary services, such as health prevention services, as determined by members.
A health care co-operative can be defined as a collective enterprise which produces services to promote, maintain and improve the health and living conditions of communities, while involving its members in the organization of its services, at the decision-making level. The members define and manage the co-operative's services and investments to suit their needs. This democratic management ensures that services offered match local needs.
Members agree to fund the co-operative's operations through qualifying shares, annual contributions and donations. Most such co-operatives receive absolutely no funding for their operational costs.
It must be noted here that the co-operative does not purport to offer health services, but rather it aims to ensure access to such services on its territory. It considers itself as having a dual role. First, it provides a competitively priced modern professional environment. Next, the co-operative aims to improve access to various health services by becoming actively involved in the hiring of physicians and other professionals, and by offering health prevention or support services to address local health problems.
While rental activities can generate independent revenues, all of the co-operative's other activities—equipment, administrative services and so on—do not generate any revenue at all, and it cannot rely on any public support. That is why members' contributions and donations from the community are requested to fund this portion of its activities. By collectively assuming this structure's operating costs, the community becomes attractive to such professionals.
It is also noteworthy that in 54% of cases, these co-operatives create a new service in the community, while in the remaining 46%, they replace a clinic that has closed or that is at risk of closing.
Doctors who decide to practice in a co-operative are paid by their provincial public system. No part of their salary is borne by members. In return, access to the physician's services is open to the entire population, to both members and non-members alike, without restriction.
Individual and collective empowerment, which are the values underlying the co-operative model, are the core elements of health care co-operatives. Rather than being mere consumers of health services, members of co-operatives are involved in their own health care and take part in the necessary follow-up. They are also asked to get involved in prevention activities.
The co-operative movement also believes in collective health management. It is managed democratically by a board of directors made up of elected members, and all members can vote at the annual general meeting on policy matters. Thus, the community determines not only how it wishes to shape its local health service delivery, but also how members will fund these projects.
We believe that between the private and the public sector, there is room for the co-operative. Health care co-operatives do not represent a privatization of health services. Rather, they are a partner which alleviates the public system's task by improving access to first-line health services and offering supplementary services. They are not-for-profit organizations that allow citizens to invest in local access to publicly funded health services.
Health co-operatives represent a wonderful opportunity for the Canadian health care system. They are an additional collective investment in access and in primary health care coverage. In that respect, this model represents a partnership opportunity for governments and communities to improve the delivery of health services. It gives back to the individual the power to manage his or her health and gives the community better access to health services.
The creation of a health care co-operative requires the involvement of many volunteers, as well as the financial commitment of thousands of members. Add to this challenge that of developing a partnership agreement with local public health authorities.
This exercise is difficult and tedious. We are dealing with small community organizations, a group of volunteers who are working to create their co-operative. Lack of funding at this stage can often discourage volunteers or slow down the project significantly.
We also believe that the government would benefit by acting as a facilitator for such communities looking to manage this crucial phase in the shaping of their local health care services. This support could take various forms, depending on the needs of the co-operative. Health care co-operatives are young, and their activities cost the government nothing. In fact they may lead to savings.
Since health care co-operatives are financially independent, they come at no operational cost to the government. By improving access to health services and by offering prevention services, these co-operatives allow the Canadian health system to better fulfill its mission and to avoid short-, medium- and long-term costs.
We believe it should be acknowledged that by voluntarily deciding to reinvest in our health system, members of health care co-operatives are first and foremost doing something positive for our society. They should be allowed to claim their contributions as medical expenses on their tax return.
The direct relationship between the members and managers of co-operatives requires ongoing innovation. In fact, members are quite demanding of their co-operative. They want to have concrete proof of how their additional contributions to the health care service offerings affect their access to these services.
The following are a few examples: the implementation of a telehealth service in order to give members in remote communities access to a public system doctor in Nova Scotia; the creation of a mobile medical clinic to service remote communities in British Columbia; the integration of a public emergency service and a medical clinic on the same floor in Beauce, Quebec; the creation of adapted services for the Native population—
