How do they do it? Public-private partnerships and universal healthcare

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I pay through the nose for health insurance for my family, and I’m not happy about it. As a U.S. citizen, I don’t have the luxury of government-backed healthcare. Since I’m technically self-employed, I have to pay the full premium myself. Want some figures? It costs me $830 a month for a family of four, with a high deductible. Besides being expensive, it takes a huge effort to deal with insurance issues, and I find that my provider is expert at finding reasons not to reimburse me for medical expenses. This is chewing a gaping hole in my budget. The only way I’ll ever get value for my money is if I’m hit by a bus.


I can only envy my European and Canadian colleagues, who don’t have to waste time or energy worrying about coverage. I hope that Obamacare, when it kicks in 2014, will provide some relief, though it’s very possible that Congress will disembowel it by then. It amazes me that the United States could put a man on the moon but can’t manage to provide decent, affordable healthcare for millions of its people.

Other governments are finding clever ways to tackle the problem. In the latest issue of Handshake, IFC’s quarterly journal on public-private partnerships (PPPs), I found plenty of examples. Ghana, for example, established a National Health Insurance Scheme (NHIS), which uses a combination of public and private coverage to provide virtually everyone with some kind of health insurance. Mexico, which is often in the news because of its battle against drug cartels, has been steadily extending health coverage for its citizens, and expects to achieve universal coverage by the end of this year. And Singapore, a tiny island nation that always seems to get things done, spends only $1,833 per capita on healthcare (compared to $7,164 in the United States) yet provides universal healthcare for its citizens. And it’s working: the average life span in Singapore is nearly 82, higher than the average of 79 in the United States.

What do Ghana, Mexico and Singapore have in common regarding their healthcare systems? First, there’s political will—their governments have made access to healthcare a top priority for all citizens, including the poor and unemployed. Second, their solutions involve a partnership between government and the private sector. This includes everything from building healthcare infrastructure to operating healthcare facilities to providing insurance.

I hope that the U.S. Congress takes note and puts healthcare above politics. In the meantime, I’d be interested in hearing from readers what their countries do to address healthcare needs.


David Lawrence

International Development Consultant

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