Double Vision: Making Eye Care Accessible through Cross-Subsidization

Facing reduced government funding, yet committed to broadening access to its services, Sankara Eye Care, a chain of hospitals in India, was at a crossroads in 2015. Over the years it had developed a lean operational model to provide free care to approximately 80 percent of its non-paying patients (cross-subsidized by paying patients). Continuous improvements and further innovation, however, were needed to achieve its ambitious goal of expanding from 9 hospitals to 20 by 2020. The case highlights Sankara's key decisions, including issues of intrinsic and extrinsic motivation, moving from a charity to a business mindset, and determining the expansion strategy.

The case provides a platform for exploring the role of non-governmental organizations in providing low-cost or free eye care services in the context of an emerging market, where inadequate public sector funding for health care often leaves large institutional gaps. It illustrates the strategies and mechanisms by which an NGO subsidizes care for the poor, and addresses issues such as financial constraints, operational challenges and cultural barriers, with an ambitious goal of country-wide expansion on the horizon.