The path to UHC is paved with good intentions. What it needs is cash.

According to the WHO, at least half of the world’s population lacks access to essential health services. All UN member states have agreed to try to achieve universal health coverage (UHC) by 2030 – but some of those already embarked on this journey are finding the going tough and the price hard to swallow. Is greater involvement from for-profit groups the answer?

The problem with supplying health services for all without the risk of financial hardship to any individual is that it costs money. This week, HBI has been speaking to an Indian operator who, while full of praise for the lofty goal of UHC, needs the government to put its hand in its pocket more.

The Indian government had committed to spending 2.5% of the country’s GDP on healthcare by 2022, up from a miserly 1% at present. Its recent budget proposes only 1.15%.

Its Ayushman Bharat scheme was designed to be a safety net for the country’s poorest citizens. But though insurers and for-profit hospitals have been leant on to support the scheme, support has been, at best, lukewarm and uptake small.

Without higher tariffs and a cap on price capping for medical devices, the government will continue to look to grossly over-subscribed public facilities with limited support to stem an unstemmable tide of patients. Incentives, to promote PPPs, and common regulations across regional borders would also help.

Elsewhere there has been (qualified) success, but that too has come at a cost. In 2016, the CEO of Ghana’s National Health Insurance Authority declared itself ‘almost bankrupt’ due to a debt amounting to around $17 per beneficiary – though it claims that debt has now been cleared. Ghana, like India, has around 40% UHC.

Indonesia has been more successful yet, with around 80% coverage – but as of October 2019, it owed $1.8bn albeit at a smaller amount per beneficiary than Ghana ($8). It is adjusting premiums upwards accordingly.

It is not enough, of course, to simply fund a scheme either. Take South Africa, where NHI reform has long been mooted. An advisor warns us that hospital-based care there is the bulk of for-profit expenditure. Treating patients at the primary and community level would save far more money – but that requires infrastructure to be put into place and again, that costs money.

What then is the solution? It would be trite of us to say we have the answer – but increased spending, embracing and welcoming the private sector in a competitive but sufficiently reimbursed environment, and putting money into primary care infrastructure where it is lacking must surely be part of the solution. Continually running NHI schemes at a loss and under-funding safety net schemes indefinitely is unsustainable.

We would welcome your thoughts on this story. Email your views to David Farbrother or call 0207 183 3779.