Purpose This study aims to highlight the processes that private organisations implement to improve access to health care services for low-income communities in Brazil. Design/methodology/approach A qualitative research based on a comparative case study was conducted in São Paulo. A for-profit organisation and a not-for-profit one were compared to scrutinise how they adapt themselves to the social context they are embedded in; while improving their service accessibility. Findings Both kinds of organisations have succeeded to reach their goal of improving the access and reducing the time frame of health care services to low-income populations. Their initial business model (BM) makes them face their own challenges that they face with different strategies. It affects their way of communicating, their organisational culture, the patients’ expectations and their level of inclusiveness. Research limitations/implications The research is context-dependent because of the specific conditions of the health public system in Brazil. When shaping health care BMs, the national context must be taken into account and the service marketing components should be used to enhance patients’ value co-creation in the health care service delivery process. Practical implications The research gives insights to organisations that seek to adapt their BM to improve health-care access to low-income populations. Social implications Health-care access plays a key role in improving populations’ living conditions and reach one of the sustainable development goals of the United Nation. Originality/value Health care services access at the bottom of the pyramid remains under-studied. The paper brings value by comparing for-profit and non-profit organisations, which have the same social goal of improving health-care access to low-income populations while developing different practices to deal with their own challenges.