Politics & Markets: The Role of the Private Sector in Universal Health Coverage

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Brendan Shaw outlines the long road still to travel to meet the UN Sustainable Development goal of ensuring basic healthcare financing for every citizen in the world by 2030 and the vital role that the private sector must play in attempting to meet this challenge.

 

The majority of developing countries will fail to achieve their targets for Universal Health Coverage (UHC) and the health- and poverty-related Sustainable Development Goals (SDGs) unless they take urgent steps to strengthen their health financing

World Bank, 2019

 

Our partnerships need to move from a transactional approach to a strategic one

The late Peter Salama, Executive Director of Universal Health Coverage & Life Course, World Health Organization, 2018

 

It is crunch time in the push to achieve universal health coverage (UHC) around the world.

How the private sector engages in this is going to be crucial.

We now have about 10 years left to achieve the United Nations Sustainable Development Goal of ensuring that every person on Earth has some sort of basic health care financial package by 2030 so that no one is impoverished by getting sick.

 

Missing our targets

And we need to get our skates on.

There has been a substantial political campaign building over the last year or so to maintain momentum and push governments to make UHC a key political issue.

Last year’s Political Declaration on UHC at the UN General Assembly highlighted the need for action and speed on this.

The World Bank’s report to government ministers at the G20 meeting in Tokyo last year on the subject is sobering.

The World Bank said that unless things change we are not going to achieve our 2030 UHC goals because not enough countries are putting sufficient funds into healthcare.

Currently, 3.6 billion people around the world do not receive the most essential health services they need – that’s almost half the world’s population.

And 100 million people each year are pushed into poverty by having to pay out-of-pocket for health services.

A study in 2017 showed that spending on healthcare by developing countries needs to increase by somewhere between USD 274 billion and USD371 billion each year to achieve the SDG health goals by 2030.

And at the World Economic Forum meeting last month the head of the World Health Organization (WHO), Dr Tedros, called on governments around the world to increase spending on healthcare by an average of 1% of GDP to inject USD 200 billion a year into primary health care around the world.

These are big numbers.

But we are not going to achieve our SDG goals if we can’t fund healthcare with these kinds of numbers.

Dr Tedros estimated this increase in health spending would save 60 million lives and increase global lifespan by 3.7 years per person.

There is a clear disparity between what is spent on healthcare in high-income countries compared with that spent in lower-income countries.

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While governments will have the key role in developing health systems, what the private sector can bring to the table here will be critical as well.

 

Role of the private sector

The private sector plays an important role in health systems around the world to varying degrees, as a supplier as a funder or both.

Given the size of the worldwide funding gap, the scale of the services that need to be developed and delivered and the innovation required to achieve UHC for all by 2030, this means the private sector has to be seen as a partner in delivering UHC.

While seemingly obvious, this is a controversial topic in global health circles.

The head of the World Bank, David Malpass, at last year’s UN High Level meeting on UHC called for more private sector investment and new private models to support UHC.

But not everyone sees it this way, with some people in the global health community wary of encouraging the private sector to be involved.

Some of this wariness is sometimes based on evidence and experience, but a lot of it is ideological.

Thankfully, in several places in last year’s UN declaration on UHC the role of the private sector and the importance of constructive engagement with business was recognised.

The key, of course, is how this relationship is structured.

As the Office of Health Economics has suggested, how purchasers contract with providers and how providers are regulated is more important than whether it is the public or private sector providing the services.

The same can be said whether you’re looking at structuring a national scheme of universal health coverage or looking at the international level strategic dialogue about UHC.

The strategic dialogue between governments, NGOs and the private sector about implementing UHC needs to improve and, according to experts at the WHO, there is currently a ‘public policy vacuum’ in many countries when it comes to engaging with the private sector.

As the former WHO UHC guru Peter Salama –who tragically passed away suddenly last month – said, the key is getting a relationship that is at a strategic rather than transactional.

This means different stakeholders in the public and private sectors finding the time, space and commitment to discuss the long-term strategic issues rather than having arguments over each individual short-term crisis when it breaks.

Encouragingly, the debate is starting to change at the international level and there have been a number of good initiatives to drive this discussion, such as the cross-sectoral UHC2030 platform.

Crucially, the WHO has put more emphasis on this engagement work and has created an Advisory Group on the Governance of the Private Sector for UHC which is currently developing advice for a global strategy on how governments and agencies can constructively engage with the private sector on UHC.

The Advisory Group has released a draft roadmap that is currently out for consultation until the end of February and will be developed through the course of 2020.

 

So what should life sciences companies do?

Given the evolving debate about the role of the private sector in UHC, there are things that companies should be doing.

  • Understand what is happening – The future business environment for private health care companies will be influenced by debates happening right now. While sometimes seen as esoteric discussions in the hallowed halls of UN agencies far from the real world of business, these discussions may well frame the role of the private sector in delivering health care in many countries for the coming decades. Spending some time on strategic thinking and planning now may help your business anticipate future developments in the emerging global business environment
  • Get involved – There is still a tendency in some quarters of the private sector to try to ignore the policy debates in global health. The expansion of UHC worldwide together with the internationalisation of health policy means that this approach is dead. The old saying that one has a choice of being ‘at the table or on the menu’ has never been truer than now. Companies should decide whether they want to be part of the debate about their future business environment or wait around to pick up the pieces after all the decisions have been made.
  • Earn trust. Really – There are many examples where the private sector has done a good job of engaging with governments, agencies, NGOs and the community and some examples where it has failed – sometimes spectacularly. The key is to earn the trust of these other stakeholders by being genuine, coming to the table with constructive analysis and recommendations and looking for progressive solutions
  • Bring your skills to the table – Companies make it their business to be able to persuasively argue the economics and the business case for their own investments. They’re good at it. These skills can be brought to the debate on the importance of investing in health care and convincing others about the economic case for investing in things like hospitals, medicines and health care professionals. Ironically, it might be private companies that are best placed to convince the bean counters and geeks in government finance departments about the benefits of investing in health.
  • Find the sweet spot – Identify those collaborative partnerships, strategies and policies that can help strengthen UHC while building sustainable new business for companies. This may require new business strategies which may be uncomfortable or ‘disruptive’, but they could help drive new revenue streams while helping to achieve society’s broader goal of affordable health care for everyone. Bringing innovative new thinking to the table is what industry can do if it is given the opportunity.

If we can get the politics of health working in sync with the markets of health rather than at odds with each other it will be better for everyone. For government, business, health systems and patients alike.

 

Brendan Shaw is Principal of Shawview Consulting based in London and Sydney and is Adjunct Senior Lecturer at the Pharmaceutical Management Unit, School of Medical Sciences at the University of New South Wales in Sydney.

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