From Chile to China, worldwide interest in health system reform and the role of the private sector is the order of the day. All over the planet, public and private health sector leaders are examining how to combine the innovations of the competitive marketplace with the larger social values of solidarity and health justice.
Today in Chile, a pioneer in health system reform and innovation, this fundamental lesson of global health politics is being played out. The new socialist government is aggressively committed to the twin goals of universal access and attracting private health sector investment. The public system is successfully competing in the open marketplace with the private health plans of Chile. Next May, a delegation of senior healthcare executives, organized by the Academy for International Health Studies, will join a trade/study mission to Santiago to monitor Chile's progress.
Fundamental structural transformations are sweeping the globe. Together, these changes offer both private and public health sector leaders an unprecedented moment in healthcare history: to establish the legitimacy and operational effectiveness of private healthcare systems and to forge public-private partnerships that serve the public interest. Economic globalization is creating new healthcare consumers and restructuring old ones.
Until this decade, international business executives evaluated markets in geopolitical terms. In the future, successful healthcare organizations will serve cross-border labor pools and virtual employers.
The new model is the geo-economic organization: For example, Royal Dutch Shell, in economic terms, is larger than Norway. Mitsubishi is bigger than Indonesia; Wal-Mart is bigger than Israel. IBM and Colombia are the same size; the same is true for American Express and New Zealand. Microsoft is as big as Spain.
Despite the fearmongering and isolationist rhetoric in some quarters, globalization is not an economic or policy impediment to healthier communities. Indeed, advancement of a nation's health begins when rising wealth buys better nutrition, sanitation, clean water and public-health education.
Globalization, as it brings economic prosperity to developing nations, inescapably expands health resources. The World Bank reports that, worldwide, for every dollar increase in national income, per-capita healthcare spending rises $1.40.
In most countries, healthcare ranks within the top five largest economic sectors. The minister for economic development ought to know as much about the health sector as the minister of health. Even in the U.S. where military expenditures equal the next eight largest national defense budgets combined, American spending on healthcare is four times greater than American military spending.
Still, politicians treat healthcare as a very expensive special-interest lobby driving social spending based on high moral imperatives but with little or no perceived compensating economic value. But no matter how efficient, productive and well-managed, health systems are always labor-intensive. A robust health sector creates permanent, good-paying, socially useful jobs.
Along with decent housing, safe roads, affordable power and clean water, effective healthcare systems alleviate poverty and build economically vibrant communities.
To the extent the private health sector finances health insurance for a segment of the population that then no longer requires public subsidies, governmental resources are made available to pay for population-based, communitywide health measures.
While in many countries governmental policies formally guarantee universal access, most health systems are unable to afford all the services needed by their communities. All too many publicly operated, ostensibly universal healthcare systems ignore those in abject poverty while serving the more affluent with poor quality and even poorer customer service.
The healthcare status quo is frequently marked by fragmented care, inequitable access, uneven clinical quality, rationing by income class or rural isolation, corrupt or inefficient management and underfunded public systems.
From Eastern Europe to Latin America, nations are setting aside statist ideologies. The triumph of marketplace politics is universally acknowledged if not universally welcomed. Industries such as telecommunications, banking and energy once considered too vital to the national interest not to be publicly owned are now being privatized. Economic health security, once an unquestioned governmental responsibility, is slowly shifting to the private sector.
In many countries the introduction of private health options is not simply a matter of healthcare cost control or rationalizing existing health resources. In contrast to mandated, single risk-pool, public systems, private sector health plans are increasing choice, not restricting it.
Let's acknowledge that it is possible to repudiate American-style hire-fire-and-expire socioeconomic policies without rejecting a balanced public-private health mix. Governments will never be rich enough to fully afford the insatiable health demands of an expanding middle class, an existing under class, rapidly aging populations and changing epidemiological patterns. The private health sector must be part of every national industrial policy.
At the same time, government isn't always the bureaucratic enemy. Without strong social safety nets, indeed without basic political and civil stability, the private health sector cannot flourish. Since the earliest of times, disease has been recognized as an equal opportunity killer, so governments have been called upon to guarantee the public's health. Virtually all modern civilizations reject reliance on the marketplace for basic public health measures.
The private sector must more readily accept that in most countries and for most civilized societies it is settled public policy and certainly settled public opinion that healthcare is a public good that should be distributed according to need, accessible to all and financed on the basis of one's ability to pay. Only the well and the well-off inject ideology into the healthcare debate.
In the heat and fury of the daily power struggle to determine who will control health resources, the major stakeholders--doctors, drug companies, health plans, hospitals and governments--have too often neglected their common and nobler purpose.