Managing Health and Healthcare as a Commons

Excerpted from George Por:

(the original version with links here)

“A group of Commons scholars inspired by Elinor Ostrom’s work, at Indiana University, conducted a fascinating research in a Working Group on Managing the Health Commons.

It provides a key conceptual building block for the transition to a Commons-based society, although that’s probably not how the Working Group’s researchers would describe what they are doing. So let us explain why we see it that way.

Michael D. McGinnis, PhD, the Principal Investigator of the research project wrote in Health as a Commons: Talking Points (.pdf), one of the group’s influential documents:

“We interpret the term ‘commons’ broadly to include public goods, including conditions ?required for the efficient operation of markets.”

It would be interesting to explore how that interpretation relates with James Quilligan’s, which distinguishes private, public and commons goods. Their interpretation of the “commons” seems to differ, given their different contexts, but those perspectives can significantly enhance each other. (It’s high on my list of targets for in-depth inquiry.)

The Managing the Health Commons WG envisions the collaborative stewardship of the health commons as “a form of polycentric governance, a complex political system in which multiple public authorities from overlapping jurisdictions as well as relevant private, voluntary, and community-based organizations govern through an ongoing process of mutual adjustment, within the constraints of general rules and cultural norms.” (Health as a Commons: Talking Points, by Michael D. McGinnis)

When the Ostrom Design Principles are applied to a complex political system, namely, the health sector, something remarkable may happen. First, let’s look at the list of its stakeholders, as outlined by healthcare commons research project:

* Physicians and Other Healthcare Professionals

* Facility Administrators (hospitals and specialized clinics)

* Insurers

* Employers (as purchasers of insurance)

* Program Administrators

* Public Health Officials

* Regulators (government agencies and professional associations)

* HIEs (and other information services)

* Community Organizations

* Individual Patients and Households

When all those groups come together as a commons, and learn co-producing and co-governing its resources, they will unavoidably run into frictions with both the existing structures and the narrowly interpreted self-interest of the commons’ constituting groups. It will take a great deal of diplomacy, mutual adjustment, and skillful, inter-group process facilitation of sufficient alignment to co-create a commons constitution, such as a Social Charter.

Recognizing the entirety of the health sector of a region as a commons raises interesting boundary issues, e.g. its relationship with community organizations operating as autonomous commons, within the larger one. Those are issues that any large-scale commons will encounter. This is one of the many areas, where an open dialogue between commons facilitators/activists and academics could be fruitful.

If the polycentric governance of the health sector, at the scale of a region, can enable better health and well-being for more people, then it could become a prototype of how Commons-inspired regeneration of other areas can also work, for example: housing, and education. Of course, given the preliminary and exploratory nature of the working group, the state of the research is such that extrapolations like those are yet a matter of speculation.

Nevertheless, the framework developed in the Ostrom Workshop has the potential to inspire a new narrative of the transition to a Commons-based society. Opening this conversation about that narrative, I invite us to explore and live into it.

It will be a challenging learning journey and we are grateful to the researchers and students of the Ostrom Workshop in Political Theory and Policy for doing the “heavy lifting.”

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