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Universal Health Coverage:

Universal Health Coverage:

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.

One Place, Many Paths

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:

  1. Care is integrated to ensure it happens at an appropriate setting
  2. Healthcare professionals have room to develop -a clear career path
  3. Healthcare facilities are accredited, monitored and evaluated by a national authority
  4. Unique partnerships form to create high quality low cost healthcare services
  5. Patients and communities are engaged and empowered
  6. Equity in utilisation is prioritised over just access to services
  7. An active and responsive agency that exists to protect citizens
  8. Public-private mix of health financing is carefully planned and pooled to yield maximum public good
  9. Purchasers actively plan what, how and from whom to buy from (a strategic purchaser)
  10. The State provides an effective overarching regulatory and governance framework
  11. Data is used to drive benchmarking, transparency, and governance

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.

Public financing and insurance is a key

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.

  • Firstly, achieving UHC will require a strong public payer - This is a model behind most of the world's most efficient UHC journeys, and helps to achieve maximum public good for the available pooled resources
  • Secondly, mandatory enrolment is key to rapid progress towards UHC. Systems that rely on voluntary enrolment or “opt out services”, simply don't see the benefits accrue to those who should gain most
  • Thirdly, countries that have pursued a 'Breadth first, depth later' strategy have seen much greater success than the reverse -this means starting with a shallow layer of coverage for everyone and improving it, rather than trying to get full UHC for a particular group or community right at the outset

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 - think about which data and why

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.

What should your organization be doing to successfully apply transparency?

  1. A consistent strategy
  2. Take the lead from innovative providers
  3. Measure what matters to patients 
  4. Fewer measures, more meaningful data
  5. Provide personalized price transparency
  6. A give-and-take approach to safeguarding patient data
  7. Promote independent narratives to improve understanding

For a practical path to improving healthcare through transparency, read “Through the looking glass."

Partnerships - let's think beyond bricks and mortar

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.

The ultimate goal of both is a 'triple win' of countries getting:

  1. for governments: maximum benefit from limited public capital
  2. for patients and the public: higher- quality health services at the same or less cost
  3. for private players: a sustainable return on their investment and expertise.

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:

  1. Sweat the small stuff -- be obsessed with the detail of the deal
  2. Active market management -- don't retreat into 'tender mode'
  3. Scaling up capacity in the public sector -- the importance of a well- resourced, specialized PPP unit
  4. Embrace, rather than resist, the politics of UHC
  5. Data systems you can trust -- a PPP can only be as good as the intelligence on which it is built
  6. From clarity of objectives to clarity of requirements -- goals, behaviours and expectations are often implicit and assumed, but a stable partnership requires as much as possible to be discussed and set out clearly.