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What does the future for health markets look like?

posted Mar 12, 2013, 5:46 AM by Jeff Knezovich   [ updated Mar 12, 2013, 5:48 AM ]
In December 2012 a group of policy-makers, entrepreneurs, academics and funders met at the Rockefeller Foundation Bellagio Center to discuss the changing face of health markets, and to consider future trends. One outcome of the meeting was the ‘Bellagio Statement’ which outlined some of the key issues that need to be tackled to ensure the poorest have access to safe, affordable, effective and equitable health services. This webinar was a chance to hear from some of the Bellagio Meeting participants and other critical stakeholders and to reflect on the statement.

Sara Bennett (Johns Hopkins School of Public Health) introduced the webinar by explaining that health markets are pervasive and critical in providing health and health related goods to the poorest. These health markets are made up of informal providers, private providers and public sector staff who are moonlighting from their day jobs. There are many gaps in our knowledge about health markets and as a result there is a lack of clarity on how to scale up effective private sector interventions or how to make their services better for the poor. These markets are not static, they are evolving and are influenced by new information and communication technologies, economic liberalization and the power and knowledge of patients and consumers. Sara explained how the Bellagio Statement makes a number of suggestions about how data collection and information systems can be strengthened in order to improve government regulation and decision-making and support better business practices. These include building the capacity of government actors to understand health markets and support to learning platforms thaat bring in an array of stakeholders.

The view from ‘big business’
Allan Pamba, Director Public Engagement and Access Initiatives at Glaxo Smith Kline, followed Sara’s presentation. He felt the Bellagio Statement was timely for a number of reasons. The global economic downturn means that donor funding for health has declined and the gap that is left is likely to be filled by the private sector. The Africa region is of growing interest to businesses, beyond philanthropy, as it is a future growth market. The companies that went early to China and India have an established and commanding market share and it is difficult to shift that regardless of the amount of money spent trying to change this. Allan argued that a cultural shift is needed among stakeholders to appreciate the role of the private sector in health care markets. They will be more than a trader, they will be building systems and infrastructure and advocating with governments to raise the profile of health and encourage commitments to health. In the future the creation of spaces for dialogue and consensus building around health-related priorities and the sharing of data will be key.

Development partners or domestic investments?
The second commentator in the webinar was Kwasi Boahene, Director of Advocacy & Program Development at the Health Insurance Fund. He reminded us that although healthcare is a public good and governments have a responsibility to provide it, health is chronically underfunded and only 25% of the population in sub-Saharan Africa have access to some kind of quality care. In his view, supporting better practice in the private sector is essential and complimentary to government action. Public sector services are supposed to promote equity but in countries like Nigeria the poor are actually accessing services through the private sector. Kwasi argued that this makes it even more important that we address failures in health markets to help minimize financial risks and improve the capacity to deliver quality care. To conclude he felt that the group in Bellagio may have overestimated the importance of ‘development partners’ in the improvement of healthcare markets. The promotion of public-private partnerships, the creation of investment opportunities, and the creation of trust at local level will be key to the future of healthcare delivery, along with the mobilization of domestic resources.

Governments need to intervene in health markets now or forever be playing catch up
Kwasi handed over to Kelechi Ohiri, the Senior Special Advisor to the Minister of State for Health in Nigeria. Kelechi reflected on how state health systems in Nigeria are sub-optimal and provide poor quality services that accentuate inequalities. They started looking at health markets about two years ago. The private sector accounted for about 50% of healthcare provision and there were gaps in regulation and information exchange between the public and private sector. There was insufficient protection from financial risk; health insurance coverage was minimal and most payments were out of pocket. The National Health Insurance scheme currently covers mainly the formal sector. Kelechi felt there were a number of opportunities for shaping health markets:
  • There is a need to review fiscal policy (such as tariffs and import duties) 
  • The regulatory framework needs to be improved, for example through accreditation and standards of care 
  • We should explore innovative financing mechanisms for health 
  • The development of different public-private-partnership models is necessary 
  • The private sector, beyond health, need to be engaged in improving markets 
Finding a common language to talk about the issues
Guy Stallworthy of the Bill and Melinda Gates Foundation was the last commentator on the webinar. Guy acknowledged that the language of markets makes many people uncomfortable when it comes to health. There is a need to find a way of communicating about these issues. It is possible to agree that health markets exist and non-state actors are better placed to deliver some services whilst simultaneously believing that: the state is ultimately responsible for the health of its citizens; collective, public or mandatory funding is the most effective, efficient and equitable way to finance healthcare; and that market outcomes are usually far from ideal. Guy argued that there are many problems in inherent in market-based provision but there are potentials for innovation in the private sector that we can build on. Finding ways for diverse stakeholders to come together to discuss these issues is an important next step.

An audio version with slide deck as well as a complete video of the webinar is now available. We will hold our next webinar in April.