"News stories have told of people waiting months, and sometimes years, for elective surgery; of cancelled life-saving procedures because of hospital bed shortages and too few nurses; of the hardships experienced by people living in rural areas when doctors have withdrawn their services; of long waits in crowded emergency rooms; of worn-out equipment and not enough new equipment; and so on."

So begins, Occasional Paper 5, published by the British Columbia Institute for Co-operative Studies, University of Victoria, Canada. The paper by Kristen Sinats, titled Health Co-operatives: A Viable Solution to the Current Crisis in Health Service Delivery describes models of primary care co-operatives and community health centres.

The paper states that an "... exception and a promising alternative to the status- quo is the community health model. This model has proved successful in a number of provinces including Saskatchewan and Quebec; it could be considered a key strategy towards solving the 'crisis' in health care". It details several case studies of successful health co-operatives in Canada.

The paper argues that the co-operative model could provide an appropriate approach towards re-thinking organisational forms for the delivery of some health services. "... Co-operatives know who their members are and, presumably, what services would best meet their needs. Co-operative members help determine what services and programs should be offered. ... A comprehensive knowledge of the member/user population allows the health centre/health co-operative to plan for future funding needs and services or programs that should be offered". Moreover, the paper asserts that there are significant advantages to building consumers and communities into decision-making and governance structures.

Despite these benefits, the co-operative health model has yet to be seriously considered, as a practical option for health care delivery, by the majority of policy-makers and health delivery people. The paper identifies several reasons for this lack of consideration:

• insufficient awareness and knowledge of the co-operative model,
• difficulty obtaining medical professionals to work in the centres,
• poor evaluation procedures of the health co-operatives, and;
• the absence of legislated legitimacy.

The paper advocates the development of a legislative and financial framework to encourage legislated legitimacy of health co-operatives. It also points out the need for educating the public and "users" of the health system as to the benefits and disadvantages of the current and alternative models of health care. In addition, the paper proposes providing policy makers with evidence of the advantages and possible disadvantages of co-operatives, through case studies, outcome research, and evaluation as well as "... developing evaluation frameworks that are consistent with the philosophy of a community health model".

The paper can be accessed at http://web.uvic.ca/bcics/.

Australia has a few health co-operatives, the most widely known being the Yeoval Community Co-operative Hospital.

Governments in Australia are currently using a Multi-Purpose Services (MPS) model to deliver health services to small country towns. The MPS Program, an initiative of state and commonwealth governments, is aimed at providing flexible, viable aged and health care services.

The MPS combines the local hospital with community and residential aged care services under the management of the area health service. An MPS is more than a hospital, in that it also includes other services such as Home and Community Care Services. The services they provide are free to consumers. Details of MPS can be found at http://www.health.nsw.gov.au/pmd/srhist/mps/whatis.html.