Reflections from the UN General Assembly: Public private partnerships need a quantum leap in scale and scope if universal healthcare is to be achieved
Mark Britnell, Global Chairman for Infrastructure, Government and Healthcare, KPMG International
The UN General Assembly is always an important date in the calendars of government and private sector leaders around the world. This year was no different, except that the two focal issues – climate change and universal health coverage (UHC) – added extra impetus to the dialogue, requiring as they do coordination on an unprecedented scale between countries, corporations and citizens.
I had the pleasure of hosting a high-level roundtable on the topic of public private partnerships and UHC, with representatives drawn from providers, investors, donors, and governments working towards ‘health for all’. The discussion was wide-ranging but time and again the theme that recurred was we need to think not only bigger in the scale of PPPs needed in future, but radically different in scope too.
Hospital buildings continue to dominate the popular conception of PPPs in healthcare, and while the world is demonstrably millions of beds short of what will be needed to achieve UHC, the needs of countries are so much broader. More hospitals will not solve the critical shortage of 18 million healthcare workers by 2030 (PDF 507 KB), nor the 3.5 billion people globally that lack access to basic primary care, nor the 40 percent of health spending globally that the WHO estimates is wasted through inefficiency.
Last year, KPMG interviewed governments and public payer organizations (PDF 2.8 MB) pursuing some of the largest UHC reforms in the world, such as India, Indonesia and Kenya. We found that there is a stark mismatch between where these actors said they have the greatest need for innovation, investment and new partnerships, and what they said is offered by their current private sector. They wanted last mile access, but were offered urban islands of excellence. They wanted scale and standardization, but were offered fragmentation. They wanted new models of primary care for the poorest, but were offered episodic services that were either overpriced or under-regulated.
Yet the tide is turning. As initiatives of breath-taking scale like India’s Ayushman Bharat (covering some 500 million poorer Indian citizens) are launched, private sector attention is taking a greater interest in the possibilities of UHC. KPMG have observed a shift in the healthcare PPP market away from mature health systems such as the UK and Canada and towards emerging economies: the middle east and South East Asia in particular. These partnerships are starting to incorporate new types of private actor too: not just healthcare providers but insurance companies, telcos, and retail chains.
What might these new partnership forms look like? We see glimpses in KPMG’s global report The Triple Win (PDF 2.3 MB), where case studies include partnerships with private training colleges to train hundreds of Indian doctors per year, private insurers bringing strategic purchasing skills to public coverage schemes in China, and a Bangladeshi telecoms company working to bring low cost health insurance to more than five million people.
More opportunities of this kind are emerging all the time. Indeed, one of the most exciting announcements of this year’s UNGA was the Rockefeller Precision Public Health Initiative (PDF 658 KB): a US$100 million project to bring population health analytics and risk stratification tools into the hands of frontline health workers in 10 low and middle income countries. Private companies such as Aetna and Optum Labs have been at the forefront of developing these kinds of innovations in the US and Europe, and it may be that the benefits found in these markets are just the tip of the iceberg compared to what they offer countries targeting far more limited resources to the most vulnerable.
There is no hiding the checkered history of PPPs in healthcare, but there is equally no avoiding the fact that many countries will come nowhere near UHC 2030 without new ideas, investment and capacity from the private sector being part of the solution. KPMG are proud to have one of the world’s largest PPP practices in healthcare, and to be working on many ‘traditional’ hospital PPPs around the world – in addition to this new wave of more innovative project designs. I passionately believe that when public and private sector align in this way then we can achieve anything that we set our minds to - even the vision of health for all within a decade.
Throughout this document, “we”, “KPMG”, “us” and “our” refer to the network of independent member firms operating under the KPMG name and affiliated with KPMG International or to one or more of these firms or to KPMG International.