Where are the ‘Toyotas of healthcare’ we need for universal health coverage?

A globe surrounded by a stethoscope.

By Jonty Roland, IGHI Honorary Research Fellow and Independent Health Systems Consultant.

By dedicating this World Health Day to universal health coverage (UHC), the WHO is continuing to relentlessly bang the drum for ‘health for all’ under its charismatic Director-General. This is a beat that more and more countries are now marching to, with dozens of governments having announced UHC-inspired reforms since Dr Tedros took office two years ago.

Many countries are following WHO’s advice and financing these reforms through large injections of public funding, for example the new national health insurance schemes planned in many African, Middle Eastern and Caribbean countries. This is generally the most efficient and equitable way of paying for healthcare.

The role of private providers

But what about the provision of all this new free or low-cost healthcare? This is more complex. Private healthcare providers frequently represent half or more of the delivery capacity in healthcare systems aspiring to UHC, and up to 70% of outpatient care in many low- and middle-income countries. Duplicating this capacity through purely public providers would be a waste of time and resources, but there are few really good examples of public payers and private providers coming together at mass-scale to deliver UHC.

Working with colleagues from the Institute of Global Health Innovation and the World Innovation Summit for Health, we wanted to find out whether the global commitment to achieve UHC by 2030 (one of the UN’s Sustainable Development Goals) was factoring into the future business planning of private providers. We surveyed 20 of the largest private healthcare chains operating in emerging markets, representing more than 500 hospitals and 7,000 labs or clinics across 40 countries. Surprisingly, only a quarter seemed to express a clear intention to shift their business and service delivery models in response to UHC (e.g. providing more publicly financed services, and more of the out-of-hospital services that governments and the WHO say are so desperately needed).

This is disappointing. Public payers interviewed for our research said they dearly wanted to be able to purchase reliable, mass-scale health services for their citizens – a kind of ‘Toyota-style’, standardised, affordable and ‘good enough’ quality option. However, this just wasn’t available in their local markets, which instead offered either over-priced ‘islands of excellence’ or unreliable independent operators. For their part, private providers said they just didn’t trust their governments to actually pay them, or properly differentiate between high-quality healthcare and ‘cowboys’.

Building bridges

This trust deficit between public payers and private providers is a major barrier to UHC. While our report pointed to a variety of things that might bridge this gap, in the meantime it may be that solutions are coming from outside of the established private provider market. Some of the most promising examples of future ‘Toyotas’ were a telecoms network, a chain of retail labs, and an AI company.

Perhaps most promising of all has been the enthusiasm of investors to work with these kinds of ‘UHC-ready’ private providers. Since publication, a group of investors has begun collaborating to better understand the market opportunities of UHC and support organisations with promising new care delivery and business models. Perhaps it’s by following this money that private providers might finally start to march to WHO’s drumbeat, too?

Healthy Returns: The role of private providers in delivering UHC, was published by the World Innovation Summit for Health and Imperial College London’s Institute of Global Health Innovation in November 2018. The report is available at www.wish.org.qa/research/forum-reports/.

Jonty Roland is an honorary research fellow for IGHI, and is an independent adviser on health system reform and universal health coverage to governments, global institutions and private sector organisations. 

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