Health needs state and private services

Health ministers from around the world are gathering in Geneva this week for the annual meeting of the World Health Organisation (WHO).

On the agenda is how to encourage developing countries to move towards universal health coverage, in which everyone in a country can access basic health services without facing financial hardship. Countries from India to Uganda have universal health coverage at the top of their domestic agendas, thanks partly to advocacy led by the WHO. But progress is being complicated by a needless debate about the role of the private sector in healthcare provision in developing countries.

Oxfam summed it up in a series of papers attacking private sector involvement in healthcare, describing it as "unregulated, unaccountable and out of control". According to this view, universal health coverage can be achieved only by a huge expansion of government-owned hospitals and clinics. But the idea that involving the private sector is antithetical to universal health coverage is bizarre.

The private sector forms the backbone of healthcare in a range of Organisation for Economic Cooperation and Development (OECD) countries, including Japan, South Korea and Germany. More than two-thirds of all OECD countries rely mostly on private outpatient care and some of the best performing countries also deliver the majority of inpatient care through private hospitals. All of these countries have achieved universal health coverage and high levels of patient satisfaction. The private sector also provides up to 80 percent of healthcare in many developing countries.

Proponents of public sector care are in effect asking governments to expand government health provision in order to duplicate existing facilities. This is not only unrealistic, it is also pointless. Harnessing the private sector to achieve universal health coverage need not be traumatic. National or social health insurance schemes should be agnostic about whom they purchase services from: private or public, as long as quality, fairness and cost standards are met.

This approach works well in many developing countries. Universal health coverage has been achieved in parts of Thailand where residents use private hospitals, which are reimbursed.

In the Philippines, pregnant women use private midwives, reimbursed by the national social health insurance fund. Expanding health insurance coverage to poor people, allowing them to freely access private providers, is well under way in Ghana, Thailand, Taiwan, Korea, Malaysia and many other countries.

The idea that notions of profit and business have no room in healthcare is perhaps understandable among those who have made a career in public health, and whose motivations are altruistic rather than financial. Even a cursory examination of most health systems, however, reveals that few countries can meet this high moral standard: pharmacies in the UK, France and in most other countries are private, profit-driven and most effective when they are well-run businesses. Dental services in most countries are private, as are outpatient clinics.

As a growing number of developing countries stand ready to redouble their financial and political commitments to making healthcare more accessible to their citizens, we do them no favours by giving them ideologically driven advice. Cuba has the best health system in the world, according to many, and the British are impressively vocal about their love of the National Health Service. But the Dutch, Germans and Japanese are - surveys tell us - no less satisfied with their private-delivery-based systems.

The WHO and the supportive aid ministries in the developed world should provide the best objective advice and evidence to developing countries on this topic. Universal health coverage is the goal; let us not be side-tracked by pointless debates. However we arrive at our goal, a great many people will benefit.

Business Day, 19 May 2015