Universal health coverage needs both private & public sectors

2018-12-05 11:21

Mixed reactions in the private and public sectors on universal healthcare coverage, with some seeing it as a threat.

It is a relationship marred by distrust and allegations of a lack of transparency – but it’s going to take two to tango and both the private and public healthcare sectors working together to achieve “one of the most pressing global priorities” – universal healthcare coverage.

But if the latest report by the World Innovation Summit for Health (Wish) on the Role of Private Providers in Delivering Universal Health Coverage is anything to go by, private providers are not too keen for the changes this might entail.

The report was released at a recent Wish Summit held in Doha, Qatar. About 2 000 healthcare experts, innovators, entrepreneurs, policymakers and ministers from more than 100 countries attended the summit.

According to Sir David Nicholson from the Institute of Global Health Innovation, one of the authors of the report, for private providers universal healthcare coverage represents both an “opportunity and a threat”.

“The opportunity comes from the chance to access a large number of patients under public contracts, often through new national health insurance schemes, such as those being rolled out by India, Indonesia, Kenya, South Africa and Egypt, among other countries.

“The threat comes from the shift in future spending trends for healthcare. In the coming decades public players will take an increasingly dominant position in low- and middle-income countries implementing universal health coverage,” the report said.

In a survey (for the report) to find out whether established private providers were preparing to take up the opportunities for new business and service delivery models that could be offered, the responses showed that most were not.

The survey showed that, although they have an essential role to play in the realisation of universal healthcare coverage, it seems private healthcare providers are not keen on changing some of the ways they do business.

The researchers, chaired by Nicholson, surveyed 20 of the biggest private provider chains operating across 40 low- to middle-income countries – representing the operators of more than 500 hospitals and 7 000 clinics or lab facilities.

“Only a quarter of providers expressed a clear intention to shift their business and service delivery models towards publicly financed universal care services. A quarter expressed a clear intention not to do this,” the report noted.

The remaining half either expressed a desire to work with governments without significantly changing their mix of patients and reach of services, or planned to broaden their delivery model but without public partnerships.

“Government is not willing to pay the costs of world-class medical care – and we do not want to compromise quality,” a private provider said.

“Doctors are in short supply and, even with salary incentives, it’s hard to get them to move to areas in which the government would like us to work,” another said.

Governments had negative perceptions about the private sector.

“The private collects data to make money-related decisions. They do little with that data to improve services,” a public player said.

Another said: “Supplier-induced demand is rife.

“The private sector has benefited from national health insurance participation as their occupancy rate has improved. But, at the same time, we see worrying rates of hospitalisation.”

The report proposed setting up a global network of “investors for health” dedicated to developing “universal health coverage-ready” approaches; a mediation service to improve the quality of dialogue between public and private sector organisations in countries that aspire to have universal healthcare coverage; and a sector collaboration charter to assess the readiness of both sectors to work together to achieve universal health coverage in countries that want it.

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April 21 2019