The book Mission Possible, takes a narrative style that offers a palette of options but no superstructure to tie the various options together. This is intentional. A superstructure can be created only on top of a solid foundation. Where UHC and its various configurations are concerned, we are still in the discovery phase. It would be premature to get wedded to a monolithic iron-clad recommendation. Each of the ideas we propose can be the starting point for a wide number of variants. Having said this, we have extracted from the book SEVEN principles that should guide the modelling of a future UHC superstructure. We start with the following principle and will publish the remaining principles in the coming weeks, before the Bangalore UCH Dialogues session, where each of these principles will be fleshed out further before putting to debate and discussion.
So, here goes, Principle 1 (the principles will appear in random order and not in order of importance)
We must hybridize the best qualities of both the for-profit and not-for-profit sector
The not-for-profit sector is cost-efficient and compassionate in handling patient needs, whereas the for-profit sector allocates resources efficiently. Instead of thinking of the two as polar irreconcilable opposites, we must combine their respective virtues to create a hybrid ecosystem that delivers the best value and quality healthcare.
A hybrid healthcare system: What is it?
The healthcare business model contains both unstructured problem-solving (“solution shops”), e.g. emergency care, and highly structured care that is procedure driven, e.g. joint replacement. The former is left to private operators can become an opportunity to drive up consumption. Hence,unstructured problem-solving type care should be handled in the public health system, whereas process/procedure oriented elective care like joint replacement or cataract surgery can be done in a factory-like mode where standardization and optimization of throughput is emphasized, and where costs are predictable and can be pre-negotiated. A system of “managed competition” can be make private for-profit entities to compete for the latter business, with cost and value (clinical outcome) being the objectives against which payments are negotiated.
A hybrid healthcare system: Why do we need it?
The scale of healthcare under Universal Health Coverage will grow exponentially. The capital and human resources required to meet this expansion do not exist within the public health system alone. Private for-profit capital and resources can be used in a complementary fashion by absorbing the burden of standardized elective factory-like healthcare services under a pre-negotiated fixed payment model, with multiple private players competing for the business. This combines the virtues of the two systems while allowing shareholders of for-profit companies to earn a reasonable (but not parasitic) rate of return on investment that will also be more predictable, unlike the current furious and wild-west style competition that does no one any good.
Comments