The United States must implement value-based care and public-private partnership strategies to attain universal health coverage. As indicated by the United Nations Sustainable Development Goals and the World Health Organization’s global health coverage goals, most people support universal health coverage (UHC) (Galvani 16). Despite rising domestic healthcare spending and accumulating evidence that such investment benefits both health and economic activity, governments continue to underinvest in healthcare infrastructure. Low-income nations are estimated to incur a $100 per capita cost for basic primary health care coverage alone while spending an average of $19 per capita in 2016, including subsidies and out-of-pocket payments (Fulginiti 32). Domestic resources, donor assistance, and personal spending in low- and high-income countries fall far short of covering costs, expanding the gap between public health care spending as a percentage of GDP in the many countries struggling to attain universal healthcare for all.
The overall level of coverage, on the other hand, is deficient. Although many countries claim universal health coverage, they are plagued by significant access and equality difficulties. As a result, they miss many opportunities to boost their overall performance. A large amount of recent research, including studies conducted by the National Academy of Medicine in the United States and a special Lancet Commission, has found that inadequate health care costs low and middle-income countries trillions of dollars in lost productivity each year (Literatus 40). Every year, millions of people die due to diseases that may have been avoided. As a result of these concerns, low-income people must pay for care, and they may have to do so from practitioners who are not linked with publicly financed hospitals and clinics.
Addressing fiscal and healthcare deficits through government expenditure and donor assistance is increasingly challenging. Aging populations, an increasing burden of chronic disease, and the likelihood of many more, and initially more expensive, life-improving medical discoveries in the future represent a danger to healthcare systems’ financial viability in the medium and long term (McEvoy 11). It is long past time to reconsider the best road toward universal health care. When it comes to obtaining universal health coverage, it will be critical to evaluate the private sector’s role and strengthen leadership in both non-profit and for-profit organizations.
Healthcare Industry Innovations and Real-Time Financial Integration are two essential issues that should be tackled. Low-cost innovation and a more aggressive combination of public and private financing are vital for long-term success in the pharmaceutical business. More cost-effectiveness is required to promote population health and financial sustainability, and new payment methods for health services and technology are the first step toward this aim. Through the deployment of these new delivery models, private capital will be funneled into developing low-cost delivery techniques. Failures to offer services dependably and efficiently are common in universal health care systems that do not incorporate the private sector. On the other hand, health entrepreneurs have found success in industries such as rural areas, where the government has recently allowed for personal enterprise engagement and accountability for meeting national coverage targets (Fulginiti 32). Although these reforms have not been fully implemented, they have produced relevant evidence about payment and other reforms targeted at stimulating innovation inefficient technology and service delivery, among other reforms.
According to the World Health Organization, the Nepali government is assisting in establishing a community-based primary care system in rural and underdeveloped areas. Narayana Health, a profit-based network of 24 institutions that treat more than 2 million patients per year, has reduced the cost of cardiac surgery to less than $2,000 (Fulginiti 32). MUSO is monitoring and caring for a community-based and person-centered program developed in Mali to ensure that individuals in danger of becoming ill or dying are not neglected or forgotten. As a result of these initiatives, children’s mortality has decreased significantly (Fulginiti 33). Although private health care practitioners are compensated for individual and population outcomes, these arrangements have yet to be widely adopted. It is past time for them to advance in rank.
Furthermore, commercial projects are projected to become more tightly linked to government spending. Separate public and private systems limit the use of personal resources to close access and quality disparities between the two systems. Individuals with lower means cannot afford the higher-quality medical care that the rich can obtain. They necessitate more government help. Government-sponsored groups, such as Muso, provide a coordinated set of benefits to low-income individuals at no cost. Muso is an example of this. Those with more financial means may be drawn to public-financed institutions that demonstrate their worth by offering timely and high-quality service. It can be challenging to distribute resources within the public health systems of many low- and middle-income nations to those who do not have access to or the financial means to pay for higher-quality treatment. Thankfully, as our personal experiences have demonstrated, this is not the case (Fulginiti 32). Mechanisms for investment and innovation should be expanded. Three adjustments are required to promote private health care innovation and investment effectively.
In this case, a shift from a service-based to a performance-based strategy is required. Governments worldwide have expressed a desire to adopt “value-based care” through financial and regulatory reforms to enhance patient outcomes. This trend is supported by many international organizations, including the World Economic Forum, the Organization for Economic Cooperation and Development, and the Group of Twenty. Despite this fact, most countries continue to pay and organize healthcare systems around providers and services rather than the outcomes that are important to individual patients and their families. Despite efforts in the United States to shift toward “value-based” patient care, most reimbursements are still dependent on the number of services delivered. To meet the SDG population health targets, the focus on health care access must remain on coverage of essential services rather than the quality of those or other innovative services or their successful implementation in practice for each individual covered by the SDG (McEvoy 11). Comparing systems reveals that compensating providers for traditional service delivery falls short of reaching UHC goals due to quality and accessibility differences.
Transitioning from paying for services to paying for health is complicated. It was created in Ghana in 2012 to gradually shift provider compensation away from fee-for-service and hospital DRGs and toward per-person payments, as seen in the graph below. Private-sector boycotts and financial and operational issues hampered the government’s efforts to execute the policies (McEvoy 11). In addition to standard pay-for-performance or outcomes-based funding mechanisms, there is a growing knowledge of the capabilities and changes needed to support long-term local capacity building for value-oriented care.
The transition to person-centered payments should be guided by realistic value-based care goals and trustworthy indications of how public monies are utilized. As part of the plan’s implementation, primary care will be broadened to address risk factors, tracked progress using simple indicators, and held accountable to practitioners. Pilots can discover new ways to provide care, which can subsequently be utilized to attract additional providers and entrants. These approaches generally emphasize customized, technology-enabled models that favor early intervention over long-term chronic disease treatment (McEvoy 11). These strategies suggest that data will be used by improving data collection, data transfer, and data tracking capabilities.
Furthermore, the collecting and sharing vital health and social data on risk factors, treatment, patient experience, and outcomes lay the groundwork for tracking results and rewarding organizations that improve health. This opportunity allows patients to make more informed decisions. While wealthy countries’ health informatics infrastructure and standards have advanced significantly, data and measurement constraints limit the quick implementation of value-based care initiatives (McEvoy 11). It is clear technological barriers are impeding developing countries from accessing advanced information technology.
We can be positive because of the WHO and IHME’s efforts to track illness burden in low- and middle-income countries. Furthermore, the International Consortium for Health Outcomes Measurement and other groups have developed promising outcome markers for common ailments. Extending data collecting and analysis to local communities and offering mechanisms for assessing providers are critical components of the effectiveness of value-based health care reform. Developing extensive electronic record systems; instead, techniques for obtaining and exploiting data must be identified (McEvoy 11). Private companies can help governments acquire, cleanse, standardize, and share vital consumer and commercial data, such as service usage and satisfaction figures.
Government subsidies can be applied to expanding and strengthening value-based care models. Individuals and groups can benefit from income-based contributions to engage in value-based health care delivery models. During the trial period, health care providers eligible for government subsidies are chosen based on the small number of patients they serve or the minimal deviations from their usual financial practices (McEvoy 11). A shift toward value-based care should occur, in which individuals and populations are reimbursed in part based on their accountability for outcomes and other criteria.
There are many ways to help low-income people acquire the same level of healthcare coverage as the rest of the population, including increasing their subsidies. In countries with a growing middle class that consumes more private health care, state subsidies for value-based care models may help shift private investment away from fee-for-service arrangements. Donations of this type could help improve the balance of public and private spending in support of more innovative care models while encouraging private investment in the development and scaling up of proven health outcomes-improving models (McEvoy 11). Rather than diverting private investment into healthcare institutions, this model attempts to leverage the money that higher-income individuals spend on themselves to generate innovative capability that benefits the entire population.
Strategies should be initiated for connecting with and supporting self-contracted service providers. On the other hand, private entrepreneurs have demonstrated the ability to increase access while cutting prices in ways that traditional health finance models cannot match (McEvoy 12). They should be more effective at leveraging their population’s influence and ideas. The World Economic Forum’s Global Coalition for Value in Healthcare may serve as a framework for hastening the transition to value-based care and leveraging private resources to form public-private partnerships that benefit underprivileged populations.
In conclusion, private resources and innovation should be used, and even the wealthiest countries will struggle to attain universal access to high-quality healthcare and improved outcomes. Partnerships between the public and commercial sectors have shown that this is not always the case. Healthcare should be offered to all, regardless of cost, since it is morally correct to do so, even if some people may go into debt and medical supplies will run out. The full impact of universal healthcare in the United States will not be known until tested.
Works Cited
Fulginiti, Nicole. The Fulfillment of the Rights to Health and Life for Minorities in the US in the Era of COVID-19: The Case for Universal Healthcare, 2020.
Galvani, Alison. “The Imperative for Universal Healthcare to Curtail the COVID-19 Outbreak in the USA.” E-Clinical Medicine, 2020.
Literatus, Rolan. “Health Maintenance Cooperative: An Alternative Model to Universal Healthcare Coverage in the Philippines.” UNTFSSE International Conference in Geneva, 2019.
McEvoy, Christian. “Universal Healthcare Coverage Does Not Ensure Adherence to Initial Colorectal Cancer Screening Guidelines.” Military Medicine, 2021.