Innovations for equity

Would you like an injection with that Happy Meal?

In Global Symposium on Health Systems Research, Uncategorized on November 17, 2010 at 9:23 pm

BY DANIELA LEWY, JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH

I started my career in education, transitioned to corporate training, and then navigated into public health. But with each professional shift – not much seems particularly different. Universal Education and Universal Healthcare; supply/demand principles at Johns Hopkins Hospital and supply/demand principles at Mars Corporation; and increased salaries for teachers, nurses, or accountants doesn’t always translate to better test scores, fewer infections, or less bankruptcy. 

So when yesterday’s session on social franchising began with a reference to McDonalds – I sat up straight. I like the intersection of seemingly disparate fields.  With approximately 32,000[i] McDonalds and 16,700[ii] Starbucks – they are model “franchises” that serve vastly different clientele. I say “franchises” because like the health world’s nuanced definitions, so too the corporate world.  Starbucks does not consider itself a franchise, but rather a coffee “program.” A recent article compared individuals’ preferences between Starbucks and McDonalds. Starbucks “programs” attract patrons whose annual household income is greater than $75,000 and hold college degrees.  McDonalds’ clients belong to households making below $30,000 per year and have a high school diploma or less[iii].

At the First Global Symposium on Health Systems Research, Social Franchise panelists stressed three goals for franchised health facilities: low cost, high quality, and access for the poor. Looks like McDonalds franchises may have been social trendsetters. Yet the speakers’ presentations showed that franchised health services are expensive, and the patients are not poor.  One goal to lower the cost is to introduce a voucher system.  But accessibility also remains a problem – the poor don’t live in convenient locations.  As for quality – health franchises are superior to their private competitors. For the greatest advantage of a franchise is that a Frappuccino or Chicken McNugget in Amsterdam tastes the same in Delhi. Though that brings up the definition of quality.  Is a BigMac quality just because it reaches some pre-set corporate standard?  This is the same question that was posed to healthcare quality.  Who defines it?  How do we define it?

Well – one takeaway is that perhaps with McDonalds serving the poor, and being twice as accessible as Starbucks – socially franchised health clinics should open up shop in one of the golden arches’ booths.  Can I offer you Artemisinin-based Combination Therapy with your chocolate shake?

[i] Mcdonalds.com

[ii] http://www.kgbanswers.com/how-many-starbucks-coffee-stores-are-there-in-the-world/1567394

[iii] http://pewsocialtrends.org/2009/02/10/mcdonalds-and-starbucks-43-yin-35-yang/

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