This research highlights the processes which are implemented by non-profit organizations (NPO) and for-profit organizations to improve the access of healthcare services to low-income communities of developing countries while enhancing their inclusiveness. The NPO CIES and the company Dr.Consulta in Brazil were analyzed. These initiatives aim to improve access to healthcare services to low-income populations while overcoming the long waiting issue of the Brazilian public healthcare system. Implemented strategies were compared to scrutinize the way they adapt themselves to the social context; while improving the service accessibility and their inclusiveness. The research question is: How profit and non-profit organizations shape their business model to improve the access and the inclusiveness of healthcare services to low-income communities in Brazil?
The Bottom of the Pyramid population represents people living with less than $9 a day and restricted access to infrastructures and essential products and services (Prahalad & Hart, 2002). Companies can contribute to improve their living conditions by giving them access to essential products and services. Doing so requires the creation of new business models and strategies which match the BoP populations’ needs, expectations, and living conditions. Tailored strategies must be acceptable, affordable, accessible to BoP populations while raising their awareness (London & Hart, 2004; Anderson & Billou, 2007). It is also necessary to build an ecosystem which integrates local communities in the organizations’ global value chain (Prahalad, 2004; Karnani, 2007; Casadesus-Masanell & Ricart, 2010) and implies the creation of inclusive business model. Consideration toward inclusiveness is growing up but few used in the BoP literature (Kolk, Rivera-Santos, & Rufin, 2014), especially for healthcare services which are weak in most developing countries (Esposito, Kapoor, & Goyal, 2012).
In Brazil, most NPO adopt a hybrid model, which is considered more flexible to create commercial and social value (Battilana & Dorado, 2010; Tate & Bals, 2016) while combining practices from different types of organization (Doherty, Haugh, & Lyon, 2014; Zahra, Gedajlovic, Neubaum, & Shulman, 2009).
This is why the business models of NPO CIES and the company Dr.Consulta, which both offer healthcare services, were compared. A qualitative approach based on a comparative case study has been used. In 2016, 21 semi-structured interviews were conducted in three neighborhoods in São Paulo, Brazil, with administrative employees, medical staff and patients of each organization.
Results indicate that both kind of organizations have succeed to reach their goal of improving the access and reducing the time-frame of healthcare services to low-income population of Brazil. Nevertheless, their ways of operating and their business models are different. CIES is sustainably offering free services due to its partnerships with the government and its hybrid business model; whereas Dr.Consulta has tailored its business model to meet low-income populations’ needs and reach a social goal. These differences seem to affect their way of communicating, their organizational culture, the patients’ expectations and their inclusiveness. The profit company struggles to be inclusive while the NPO needs to use business and management techniques from the commercial sector, which can explain the adoption of a hybrid model.
