www.futurehealthsystems.org

Dr. Sara Bennett 7 March 2013

Shaping future health markets: Reflections from Bellagio

What future for health markets?

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Why health markets?

•  Health markets are pervasive o Health related goods and services o Sub-national, national and global o Public and private sector actors

•  Understanding how markets work will enable us to intervene in them better, particularly to protect the poor.

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Health markets - The past 20 years

•  Have learnt much: heterogeneity of private providers, “informal” markets, contracting for services, social marketing

•  But much still to learn: scaling up effective market interventions, improving quality of services, especially for poor

•  Increased importance of health markets: due to economic growth, new technologies e.g. ICTs, economic liberalization

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Evolving market

dynamics

Consumer-side • New technologies • Consumer education • Non-communicable

diseases

Supplier-side • Consolidation to

stronger players • Vertical integration

Governance-side • Push for UHC • Public finance for

private providers? • Oversight

Health markets – The next 20 years?

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Process

Landscaping analysis • Document

review •  Interviews with

range of stakeholders

Identification of key topics •  Regulation of

health markets • Networking

providers •  Learning in

health markets

Preparation of background papers •  Scoping papers

and literature reviews

Bellagio meeting (December 2012) •  Consultation

with diverse stakeholders

Research uptake activities •  Bellagio

statement • Webinar •  Journal special

issue • Meeting with

HANSHEP

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The Bellagio Statement

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Strengthen data

•  Lack of data on health markets continues to plague decision making

•  Identify key data that health market actors should provide o  Require data provision as part of participation in

government financing schemes

•  Pilot a market data platform – that draws together different types of data from diverse sources (eg. DHS, NHA, market research)

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Experiment with regulatory approaches

•  Effective regulation requires bundles of regulatory approaches

•  Dynamic regulatory approaches are required to respond to dynamic market situations

•  “Learn and do” o  Regulatory experimentation

o  Real time, rigorous, assessment of effects

o  Adaptation of strategy

o  Lessons learned?

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Strengthen government stewardship capacity •  Governments frequently lack appropriate capacities to

manage health markets

•  Develop individual skills and organizational capacity for:

Leadership skills –

to balance powerful interests

Technical capacity –

to develop market

information systems,

contract out

Collaborative capacity –

to work with civil society,

private providers, business

Analytical skills –

to anticipate future

developments in health markets

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Sustain investments

•  Donor funding has supported private sector experimentation e.g. social franchising

•  Such initiatives – often small scale, but some provide critical services to poor

•  How will these be sustained going forward?

•  While initiative seek to develop sustainable models, government financing is key to enabling access for the poor

•  Needs to be proactive engagement with government on future sustainability

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Link market and health worker policies

•  Connections between health workers and health markets insufficiently acknowledged: o Moonlighting o Migration

•  Future for community health workers, if governments do not funding their salaries?

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Learn about and manage networks

•  Business models are evolving – greater networking and integration of previously disorganized private providers?

•  Networks can help to correct failures typical of health markets: o  Informational asymmetries

o  Facilitate distribution of subsidies

•  But, networks can also create monopolies and exert political influence

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Promote learning in health markets

•  Better coordination and more consolidated research on health markets needed

•  Priorities?

•  Real time learning – need for alternative evaluation approaches

New regulatory

approaches

Effects of information on consumer

behavior

Mobile and informational technologies

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Next steps

•  HANSHEP – knowledge priorities group •  Collaborate with developing countries to

pilot data collection systems for health markets

•  Create a challenge fund to support experimentation and learning on health markets

•  Broaden the debate, in particular including more market actors

www.institutions-africa.org

The Africa Power and Politics Programme is a consortium research programme funded by the UK Department for International Development (DFID) and Irish Aid for the benefit of developing countries.

Future Health Systems is a research

consortium working to improve access,

affordability and quality of health services

for the poor. We are a partnership of leading

research institutes from across the globe

working in a variety of contexts: in low-

income countries (Bangladesh, Uganda),

middle-income countries (China, India)

and fragile states (Afghanistan) to build

resilient health systems for the future.

sbennett@jhsph.edu www.futurehealthsystems.org