Achieving UHC remains one of the biggest challenges of our generation.
Unlike the delectable festive menus we await over the coming weeks, we are challenged by the unsavoury facts that an estimated 400 million of our people lack access to essential healthcare.
Over a hundred million people are being impoverished annually or incurring catastrophic health expenses. We now have a clear choice - either carry on with business as usual or be bold by marrying innovation with tried and tested ingredients to achieve health for all. Our Center for UHC is a hub for a growing global portfolio of projects to help countries achieve “Health for all”. It is a one stop shop that packages KPMG's health systems reform expertise – from a network of 50 country practices and 4500 highly qualified health professionals – to make it accessible to clients in emerging economies embarking on large scale UHC initiatives.
Despite the diversity of opinions about how UHC is achieved, there is only one 'place' that matters – the place where a citizen is assured of care at a setting close to home; a clean health facility; an empathetic nurse; a well-trained and compassionate doctor; safe and affordable medicines; and access to consistent care, free of the fear of financial devastation. Such a place can only exist when we put together some key ingredients:
While there is no one size fits all approach to delivering UHC, most countries embarking on UHC reforms will need to find ways of making these 11 ingredients contextually relevant. While we acknowledge this diversity, our experience of health systems reform across the global suggests some basics that cannot be ignored.
In KPMG's Report on "Universal Healthcare: One place many paths" we share a few of insights from our study of UHC systems around the world.
Also read our summary insights from previous UHC implementations around the world at “Lessons the world has learnt on the path to Universal Health Coverage”. We explore both what success looks like and what failure can teach us, and ask questions such as “what does it take to implement UHC?”
Learn about China's healthcare reform journey in "Sanming: The real story of grass-roots healthcare transformation in China."
Transparency in healthcare has heralded much promise, but has often failed to live up to its expectations of transforming quality and cost. Too often progress has been symbolic and has given rise to bitter disputes between political ideologues and resistant provider and professional groups. Even countries that have led the field are now facing difficult questions about what value is really created for all their effort.
Evidence from our research shows that, like any tool, transparency can be used to create benefit or harm, or a bit of both. On the one hand, there is good evidence of data publication leading to quality improvement drives, better data collection and even improved health outcomes. On the other, it can undermine trust, lead to too much focus on particular measures, and lead to erroneous conclusions and policies. Where transparency is applied in a disciplined way by national and local health systems we believe it can make a substantial contribution to the quality and value of healthcare.
For a practical path to improving healthcare through transparency, read “Through the looking glass."
The global picture of public private partnerships (PPPs) is changing. Following more than 15 years of expansion and innovation in high-income health systems, enabling in some markets the largest renewal of healthcare infrastructure in their history, PPP appears to be a declining force. At the same time, health systems in Asia, Africa, Latin America and the Middle East are gearing up for their own unprecedented expansions in access to care. UHC is an idea whose time has come, and governments around the world are looking at how private sector partners can contribute investment and skill to help them achieve it.
For governments and citizens, PPP offers one way of containing the seemingly 'bottomless pit' of UHC's potential costs, by capping commitments into the long term and leveraging lean models of care provision. For the private sector, UHC-focused PPPs offer the opportunity for large-scale projects in healthcare markets experiencing levels of growth not seen in the West for a generation.
As more and more governments look seriously at PPP as a means of affordably improving the availability and quality of healthcare, there will undoubtedly be many projects that follow the traditional applications seen in high-income health systems -- namely, hospital building. With low- and middle- income countries averaging half the number of hospital beds per capita in high-income countries, there is no shortage of work needed here. However, there are signs that PPPs' contribution to UHC will not only be in 'me too' projects to build, maintain and operate hospitals. Conversations with public and private sector partners across the world reveal an appetite to think innovatively about where else and how else the `triple win' can be applied to developing health systems. Let us think of primary health care that has the ability of managing 60 percent of health care needs, and how digital innovation offered by the private sector can be used to scale up such services.
The success or failure of PPP in helping to achieve UHC will stand or fall on an ability to combine the lessons of the past with the creativity of the future.
A KPMG report "The Triple Win: Rethinking PPP for UHC" concludes with six insights from KPMG's most experienced global leaders on what this means, practically, for countries on the 'health for all' path: