The New Health Economy, the Private Sector, and The Road to Universal Health Coverage

Understanding the roles of the private sector as part of the roadmap to Universal Health Coverage (UHC) at the country level will be indispensable to helping most countries achieve UHC by 2030. A new book edited by Jeffrey L. Sturchio (Rabin Martin), Ilona Kickbusch (Graduate Institute of International and Development Studies, Geneva) and Louis Galambos (Johns Hopkins University) provides a range of insights into the extent and impact of the global health economy and how private firms are contributing to improving population health outcomes. In this blog, the editors outline the perspectives addressed in The Road to Universal Health Coverage (Johns Hopkins University Press, 2019):  

Universal health coverage (UHC) – defined by the World Health Organization to mean that “all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship” – is at the heart of the Sustainable Development Goals, adopted by all UN Member States in 2015. Like many ambitious global goals, UHC remains an aspiration for many countries. Today, the WHO estimates that half the world’s population – some 4 billion people – continues to be without access to basic health services.  This staggering number masks inequities that continue to exist from country to country: gaps between rich and poor, men and women, young and old, and among people of different ethnic backgrounds. UHC promises to give people greater access to high-quality health services without the fear of financial hardship. But the task of turning this vision into a reality poses a significant challenge for countries, rich and poor alike.

We recently edited a new collection of essays on The Road to Universal Health Coverage: Innovation, Equity and the New Health Economy, published in January by Johns Hopkins University Press. Our book focuses on the new health economy, the innovative power of the private sector’s involvement in UHC, and the sometimes controversial dimensions of the role the private sector can play in helping countries to achieve UHC. Each country will chart its own course to UHC, deciding which health services to cover, who will be covered, how to pay for those services, and how to ensure effective and efficient delivery: as WHO Director-General Tedros Adhanom Ghebreyesus notes in his Foreword to our book, “all roads lead to universal health coverage….”  Already, more than 100 countries have begun to make efforts toward this goal—some with more success than others.

Based on a conviction that the public and private sectors must work together in an optimally functioning health system, the essays in The Road to Universal Health Coverage explore the contributions that the private sector is already making to help countries achieve universal health coverage – and offers perspectives on how to learn from successful models. The contributors look at the global health economy from a fresh perspective, one that stresses the many positive aspects of developments currently satisfying important demands by providing new goods and services.  All other things being equal, economies that invest in health and provide strong healthcare services and outcomes bolster their human capital and are more successful over the long run. The emerging health systems also provide a remarkable array of jobs, including important work for women in a distinctly labor-intensive sector. As our contributors point out, private sector actors are already experimenting with a wide range of initiatives that have yet to receive the attention they deserve.  In many cases, dynamic health markets are leading to improvements in population health, and public-private partnerships have emerged as important contributors to the UHC movement. In many lower- and middle-income countries, the private sector provides anywhere from 30 – 80 percent of the health services, yet most policy is geared toward public sector provision, which in most cases struggles with building the infrastructure and finding the resources to provide sustainable health improvements for all. At the same time, the global healthcare market is now estimated to be some US $10 trillion and growing faster than GDP in many countries. What if we could disrupt the usual patterns of investment in global public health by thinking differently about how to harness health markets in the service of health for all? A small change in the allocation of these resources could lead to a transformative impact for billions of people around the world.    

As Ilona Kickbusch observed at the recent IFPMA 50th Annual Assembly in Geneva, Switzerland, achieving UHC will involve political choices, in addition to technical issues. Key principles of an effective approach to UHC will include seeing health as a human right, an investment and economic force, and a social contract.[i] The Road to Universal Health Coverage explores these issues in the context of how countries can chart their path to UHC using the complementary capabilities and resources of both the public and private sectors. What are the conditions required to begin to translate their successful experiences and policy promises into practical results for population health?  We look to the political, economic, and social implications of moving from aspiration to implementation. Throughout, we attempt to be realistic about the public and the private sectors’ resources and capabilities. What range of capabilities are private providers and companies already bringing to the challenges of expanding delivery of essential health services to all? Which of those capabilities blend best with existing public institutions and programs? How can these trends be encouraged while ensuring appropriate attention to questions of governance, stewardship, and equity in evolving health systems? These are some of the questions the book addresses, pointing the way to the many opportunities ahead as companies continue to work with governments and civil society partners to help achieve the goal of UHC and improved health for all.

Jeffrey L. Sturchio is the president and CEO of the global health strategy consultancy Rabin Martin and a visiting scholar at the Johns Hopkins Institute for Applied Economics, Global Health, and the Study of Business Enterprise. Ilona Kickbusch is the director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva. She is a coeditor of The European Union as a Global Health Actor. Louis Galambos is Research Professor of History and co-director of the Institute for Applied Economics, Global Health, and the Study of Business Enterprise at Johns Hopkins University. With Jeffrey L. Sturchio, he is the editor of Noncommunicable Diseases in the Developing World: Addressing Gaps in Global Policy and Research. Together, Sturchio, Kickbusch, and Galambos are the editors of The Road to Universal Health Coverage: Innovation, Equity, and the New Health Economy