Sink or Swim: Using Crowdfunding to Support the Uninsured

Burden of Medical Costs on the Uninsured

In 2011, there were nearly 50 million uninsured adults and children in the United States (Kaiser Family Foundation 2012). As 43% of uninsured adults consider cost to be a barrier to obtaining medical treatment, identifying innovative strategies to support uninsured individuals burdened with excessive medical costs is critical to ensuring overall health as well as economic wellbeing and livability for too many American families.

According to the Kaiser Family Foundation (2010), the uninsured pay for 35% of their care from their personal funds and are three times more likely than the insured to be unable to pay for basic needs because of medical expenses. Further, 20% of these uninsured individuals have emptied their savings accounts to pay for medical bills. Among Southeastern Pennsylvanians, Public Health Management Corporation’s Community Health Database (2012) finds that nearly 12% of individuals age 18-64 are uninsured and that adults living below 150% of the Federal Poverty Level are 24.3% more likely to be uninsured than their counterparts. The uninsured are also more likely to be in fair or poor health and are less likely than others to not have a regular source for care.

An Innovation is Born: Sink or Swim

As the Assistant Director for Clinical Research at the University of Pennsylvania’s Center for Resuscitation Science, Cardiac Arrest, Research Education and Clinical Care, Marion Leary had heard from scores of individuals who, in the midst of dealing with sick loved ones’ health concerns, were tormented by the question of how to pay for their medical care. In several cases, patients were forced to decide between paying for medical expenses one week and paying for groceries the next. Eventually, Leary decided she had had enough. As she recalls, “I couldn’t sit around and watch anymore. I had my event background. These friends were asking me to help put on these fundraisers, separate fundraisers. I wanted to mold it into a sustainable organization” (Leary, personal communication 2012).

With her interest in event planning and fundraising, Leary began following Kiva.org, a microlending site for small business in the developing world. Inspired by the Kiva model, Leary decided to replicate it by helping connect individual donors with uninsured and underinsured Philadelphia area residents who were facing significant medical costs.

Lacking the start-up capital to develop a web-based lending platform from scratch, Leary debuted Sink or Swim (SOS) on Facebook. Subsequently, Philly Stake, a local funding organization that aims to support community engagement projects, stepped in to provide the money necessary to build a website and enhance outreach. “We could have probably kept doing it on Facebook, but we needed a place to tell our story, so we created the website” (Leary, personal communication 2012).

SOS connects with in-need individuals through social workers and hospital health workers, tabling events and outreach materials. There are no strict requirements for becoming a featured individual on SOS’s website and SOS will feature any illness or injury. However, SOS does vet all applicants to the site by contacting healthcare providers, insurance companies and/or collection agencies to confirm the accuracy of all information provided. Once confirmed, that individual will be featured on SOS’s website for a month. During this time donors from across the country can donate any amount towards that person’s medical costs. Almost all money received through this campaign goes directly to creditors.

Sink or Swim’s core mission of providing a pathway for donors to give directly to those in need differs from other donor organizations. Leary acknowledges some lack of transparency regarding how other large donor organizations utilize their funds. “We feel like when you donate to big organizations, you do not know where you are giving/who you are helping. That’s also part of the social innovation, direct connection to recipient” (Leary, personal communication 2012). With low overhead and a team of committed volunteers and board members, SOS is able to dedicate 90% of the amount fundraised to featured individuals.

A First in Philadelphia for Medical Crowdfunding

The idea of medical crowdfunding is not entirely new, and has in fact gained considerable traction through a variety of for-profit websites like GoFundMe, YouCaring and GiveForward. In a recent posting on NPR’s health blog, GoFundMe CEO Brad Damphousse shared that in 2012 alone, the site's users have raised more than $6 million for medical causes, and that “Medical, Illness & Healing” is the site's most popular category, attracting 17% of total donations. However, these sites differ from the SOS model in that, for the most part, individual fund-seekers set up their own accounts and are not necessarily vetted by any central source (Barclay 2012). 

Similarly, the idea of locally focused crowdfunding has recently made its mark in Philadelphia through projects like Philly4Philly, which is powered by the umbrella organization Citizen Effect. Building off of the success of a similar project in Detroit, Citizen Effect has worked with local nonprofits to identify 150 high-impact projects and recruit Citizen Philanthropists (CP) to take on the role of chief fundraiser for one of these causes. The CPs leverage their connections to family and friends, as well as their social networks, to promote their chosen project and reach a fundraising goal. As with Sink or Swim, each project (or, in the case of SOS, patient) has been vetted to ensure that donors are investing in a legitimate cause (Philly4Philly 2012).

SOS has managed to combine some of the best practices of each of the models noted above and stands out in Philadelphia as the only local medical crowd sourcing initiative. For Leary, the innovation of Sink or Swim is “bringing a community together to make a change that hasn’t been done before” (Leary, personal communication 2012). Namely, SOS has capitalized on the growing interest in medical crowdfunding as evidenced by programs like GoFundMe and others, while at the same offering a local focus and the security of a formal vetting process to help engage donors. One testament to the success of SOS is that, despite its local focus, SOS has been able to procure donations from more than 25 states.  

An additional positive side effect of medical crowdfunding seems to be fostering a broader culture of giving and the notion of ‘paying it forward.’ Leary recounts a story of a woman going through chemotherapy featured on the SOS website who, despite facing incredible challenges, continually asked how she could help SOS. Inspired by the courage and perseverance of featured recipients, Leary says, “This just amazes me. They shouldn’t have to worry about this” (Leary, personal communication 2012). Critical to the Sink or Swim crowdfunding model is harnessing this generosity among donors and recipients alike, and then keeping those donors and recipients engaged over time. Reflecting on a recent one-year anniversary celebration, Leary emphasized the importance of the event as an opportunity to celebrate Sink or Swim recipients. Through such investments in engagement, Leary seeks to keep donors and recipients involved, ultimately maintaining a small, local and community-based culture.

Current Achievements and Sink or Swim’s Future

Since its inception in 2011, Sink or Swim has moved from using Facebook as its primary platform to maintaining its own website as a means of connecting donors and featured individuals. According to Philadelphia Generocity (Kane 2012), Sink or Swim has had nearly 17,000 visitors to its website since April 2012 and increased its reach on Facebook by 3,000%. With increasing exposure, Sink or Swim is gaining traction as a high-quality local philanthropic organization. Most notably, Sink or Swim’s success is due in large part to a group of committed volunteer board members and staff that find fulfillment in providing solutions to individuals in desperate situations.

Moving forward, Leary hopes to grow the program in a manner that will enable her to have more than one recipient per month or provide a debt reduction program to reduce the amount they owe. With an eye toward increased sustainability, Leary also envisions a micro-lending program whereby recipients of funding could pay back monies received, which could in turn be distributed to future recipients. Regardless of the outcome of any micro-lending plan, the current model is sustainable given SOS’s low overheard. With additional funding or committed partners in Philadelphia, the program can grow to take on full-time staff and work towards replicability. However, when it comes to expansion, Leary believes in wanting “to know [featured individuals’] stories. Know what they’re feeling. There have been people from all over the country asking how they could start a similar thing in their area. That’s definitely something we would consider but we would have to have the right partners in place” (Leary, personal communication 2012).

References

Barclay, E. (2012, October 24). The Sick Turn to Crowd Funding to Pay Medical Bills. NPR. Available at http://www.npr.org/blogs/health/2012/10/23/163489063/the-sick-turn-to-crowdfunding-to-pay-medical-bills.

Community Health Data Base. (2012, April 5). Data Findings: The Uninsured in Southeastern Pennsylvania. Public Health Management Corporation. Available at http://www.chdbdata.org/datafindings-details.asp?id=99.

Kane, E. (2012, October 26). Offering a Life Raft to Uninsured, Sink or Swim Philadelphia Turns 1. Generocity. Available at http://www.generocity.org/2012/offering-a-life-raft-to-uninsured-sink-or-swim-philadelphia-turns-1/.

Kaiser Family Foundation. (2012). The Uninsured: A Primer. Available at http://www.kff.org/uninsured/upload/7451-08.pdf.

Kaiser Family Foundation. (2010). Kaiser Commission on Medicaid and the Uninsured.  Available at http://www.kff.org/uninsured/upload/7806-03.pdf

Leary, M. (2012). Personal communication.

Ordanini, A., L. Miceli, M. Pizzetti and, A. Parasuraman. (2011). Crowd-funding: transforming customers into investors through innovative service platforms. Journal of Service Management, 22(4): 443-470.

Philly4Philly. (n.d.). About Philly4Philly. Accessed December 5, 2012, http://www.philly4philly.org/about/.