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With the recent coronavirus outbreak, we have seen that the proactivity of a government responding to the crisis is highly-correlated to the extent of the spread in a country. At the same time, this has revealed the enormous stakes that the public healthcare system holds – as the first line of defense against novel epidemics – in containing the spread.
It’s making us relook at the current healthcare delivery models we have in place to support increasingly-changing demands of our environment- with emerging diseases, therapies, certain demographics dominating the population, and digital disruption reinventing healthcare provision and moving service out of the traditional hospital or clinic.
Why this warrants a public health approach
Even in neoliberal economies like the United States where they have some of the world’s best doctors and most renowned private healthcare providers, one article cites “Containment is not only about science and equipment. It’s about people and collective action. Success is rooted in social solidarity.”1
Henceforth, individual preparedness may not be sufficient when it comes to tackling a community health problem, but the skillful coordination of resources and partners by the government as it plays an overarching role of bringing together the relevant ministries, private sector, non-profit organizations and the citizens; and building synergy to sustain cooperation in community efforts.
Also, there are those who cannot afford to be prepared when test kits have been absurdly expensive2 and then those who are economically-disadvantaged would have to choose between getting tested for this contagious and possibly deadly disease versus saving USD $1,400 which could possibly be a month’s wages spent on food and other living expenses. 3 With an incomplete safety net and inadequate health insurance, this means that people don’t go to the doctors until they are very ill.
Other problems that plague the system
The effects are compounded by the rise of the gig economy where workers may not be entitled to basic employment benefits like sick leave, and food delivery riders also put themselves at risk when exposed to quarantined customers. Employees advised to quarantine themselves for the welfare of others also forego part of their income or risk losing the job. Without an alternative source of income, it only makes sense to grit one’s teeth and carry on working.
Emergency departments in many places are already burdened by crowding conditions and this is exacerbated during times of crises. Complex regulations also make it challenging for its private counterpart to close the remaining gap- E.g. US FDA recently lifted a key regulatory hurdle which previously implemented tight control over the private sector’s involvement in diagnostic work for COVID-19.4
What is in the “universal” when it comes to healthcare coverage?
Among intergovernmental organizations, they hold different definitions of what UHC means. Even the World Health Organization (WHO) holds a conservative definition of the term and an interesting component of the definition is that “the use of services does not expose the user to financial hardship.” Therefore, it does not necessarily mean healthcare free for all. The definition also does not specify a hard and fast rule on how it’s being provided, who provides it, and the extent of healthcare to be provided to the individual.
Food for thought is that given long waiting times – which tends to burden public hospitals – end up killing than ailing5, then what good is “universal coverage”? Accounting for the quality and efficiency of the public health system which includes timely access, how do we then build a healthcare model that’s built to last for the benefit for everyone?
Role of the Private Sector in the delivery of UHC
The private sector plays a substantial role in healthcare delivery, much more extensive and diverse in developing countries where the public health is fragmented.6 Let us keep in mind that what we mean by private stakeholders do not only mean MNCs, but also family doctors, traditional medicine practitioners, and local midwives in the small town.
Many people regard the private sector’s involvement to be antithesis with the universal provision of healthcare; but studies have shown that the co-existence of private for-profit healthcare providers sets up competition for the already-extensive public sector to do better at what it does and tends to play a complementary or supplementary role to fill the remaining gap in the system.7
A study by Phua (2017) sheds light into the poor’s receptivity towards private healthcare providers – that bureaucratic barriers, long queues, and bad attitudes of health staff in the public sector have led many poor to seek private sector services even when the first is entirely publicly-subsidized; and that cost is not the only factor influencing the choice of provider by the poor.
In a discussion convened by Save the Children and GSK as part of the first UN High Level Political Forum on Sustainable Development Goals (SDGs)8, there was a key message being delivered on the role governments play as an overarching analyst and coordinator for both public and private resources:
“While a mixed system can be highly effective, national governments must lead the way in providing a basic package of publicly funded healthcare services which can be supplemented and complemented by a well-monitored and incentivized private sector. The starting point for any government must first be to understand the balance within its own health system, and then to use the understanding that exists from all healthcare stakeholders, public and private, to plan for the future.”
While it is important to strengthen the supply side of the healthcare market, private sector engagement may still run the risk of being a substandard choice when the government does not hold an explicit policy position on the role of private sector in healthcare provision and that there are no existing regulatory frameworks to govern the players.
It would be erroneous to rely only on the government to build a comprehensive UHC system. At least, the role of the state is should not be restricted to being the sole provider of healthcare services as this would disrupt market forces and severely limit the effectiveness of the healthcare system. Key to its role would be facilitating service provision by other significant stakeholders in the ecosystem like private healthcare providers and the civil society.
Are conventional service delivery and financing models well-equipped to cope with digital disruption and other emerging demands in the healthcare environment?
Co-locating three (3) conferences which will cover the financing, healthcare facility and digital tech aspects of expanding the affordability and accessibility of healthcare, Informa Connect’s 6th Asia Healthcare Week returns better and rejuvenated. This umbrella event spans three co-located conferences that will address a wide variety of aspects regarding the direction of healthcare and what it takes to revamp and prepare healthcare businesses for emerging priorities in the sector.