Ohio Considers ‘Social Impact Bonds’ for Public Health Challenges
Ohio Treasurer Robert Sprague is proposing to turn to the private sector and local governments to help deal with two of the state’s most troubling health care challenges: infant mortality and opioid drug addiction.
Sprague proposes using so-called social impact bonds to encourage nongovernmental organizations to create innovative solutions and reward them based on results.
Sprague calls the program ResultsOhio. The state legislature approved the first pilot program last year as part of its budget bill. Although the pilot program will deal with a criminal justice issue, recidivism, Sprague says ResultsOhio is a natural fit for treating problems such as drug addiction.
“The thing we struggle with is a very low rates of recovery,” Sprague told the Tribune Chronicle in a November 26 article. “So, this ResultsOhio program was born out that necessity.” “We’ve tried hard and invested a lot of money in the treatment system in Ohio,” Sprague told the Associated Press on June 28. “But our recovery rates are stubbornly at 10 to 15%. So how do you have innovation occur in the system to increase those recovery rates?”
The legislature and governor would have to approve a specific application to addiction or other health challenges and set desired outcomes. Programs would have to find independent funding sources, and if they show results, the state would reimburse the costs and provide a small return on investment.
The social bond concept makes good sense for treating drug addiction, says Jordan Roberts, a health policy analyst at the John Lock Foundation.
“While treatment for those addicted to opioids is an essential part of recovery, just focusing on treatment doesn’t address the core problems of why people turned to using the drugs in the first place,” said Roberts. “We need to focus on the root causes of why someone would choose to abuse opioids. This is where I see the private sector playing a more impactful role than the government, to stop people from abusing opioids in the first place.”
Government spending has done little to stem the tide of drug addiction and related public health crises, says Alita Eck, M.D., a practicing physician and proponent of private-sector responses to health challenges.
“Governments set up programs, hire people, and buy computers and printers, but until we can make a difference in the hearts and minds of those who are addicted, we will not have made a dent in the crisis,” Eck said.
Massive government health care programs have long had a monopoly on treating drug addiction, with little success, says Roberts.
“Medicaid and Medicare have intruded so far into the market that they cause more problems than they solve,” said Roberts. “I believe scaling back government overreach in the health care sector will create new opportunities for the private market and private actors to address these problems.”
Voice of Experience
Eck has personal experience demonstrating smaller programs are better at addressing problems like addiction. The book The Tragedy of American Compassion, by Marvin Olasky, inspired her to take action.
“Olasky outlined the failure of government to replace what church and civic groups used to do,” said Eck. “His book inspired my husband and me to start the Zarephath Health Center 17 years ago. Run by volunteers, we provide personalized care to those who are struggling. We can channel people into faith-based addiction support groups with a proven record of success.”
Workers in government programs can be overwhelmed by large-scale problems such as addiction, says Eck.
“The volunteers are motivated to help, as it is not just a job for them, and many former addicts have the experience and knowledge to empathize with those who are struggling,” said Eck. “Government programs tend to be impersonal. While good people may be employed by them, they are too often constrained by rigid rules that keep them from personalizing the intervention addicts need.”
‘All Solutions Are Local’
When it comes to tackling big health care problems such as addiction, a smaller-scale approach works better, says Eck.
“All solutions are local,” said Eck. “Local communities and churches need to see the mission and band together to tackle the tough issues.”
Ashley Herzog (firstname.lastname@example.org) writes from Avon Lake, Ohio.
ResultsOhio, “How a ‘Pay for Success’ Model Works”: https://results.ohio.gov/how-it-works/