International support for universal healthcare, free at the point of use
While the world’s governments attempt to move further from universal healthcare, towards privately funded options, they are increasingly out of step with the broader population. A new survey from Roland Berger shows that a majority of citizens still favour the idea of strong, publicly funded system – while placing healthcare as a top state spending priority, ahead of education and defence.
Publicly funded healthcare is a form of health care financing, designed to meet the cost of all or most healthcare needs from a publicly managed fund. In many developed economies, this saw the universal delivery of healthcare as a public good, free at the point of use, and paid for by general taxation. While it has taken on different forms in different countries, the UK’s National Health Service remains one of the most recognisable examples of this in practice.
After the NHS launched in 1948 under the Labour government of Clement Attlee, health services which were previously only accessible to the wealthy have become something which every citizen can take for granted. As a result, the country has seen a dramatic transformation in its health prospects – with infant mortality falling from 36 per every 1,000 live births, to just under four. At the same time, it enabled public health initiatives such as vaccine drives to be rolled out more effectively – with pre-vaccine outbreaks reaching as many as 8,000 yearly cases, before effectively being eliminated by the 1970s.
Life expectancy has subsequently increased drastically – rising from 65 for men and 70 for women in 1948, to 79 and 83 respectively by the NHS’ own 70th birthday. In spite of this success story, criticism remains among political actors at the institution, which they feel does not provide the ‘efficiency’ the private sector can. In other countries, these pressures have seen other nations like France and the Netherlands introduce mandatory membership of private insurance policies; while in the UK, successive governments have encouraged private contractors to provide services within the NHS. A new survey from Roland Berger suggests that the general public does not support this shift, however.
Public over private
Surveying more than 5,200 people across 25 countries, spanning all income brackets and age groups, over 70% said they were in favour of a publicly funded healthcare system, free at the point of use – including 32% who agreed to the strongest degree. In contrast, 30% erred toward a system based on private or personal contributions – with just 7% agreeing with that to the maximum extent. Analysing successful national healthcare systems against these findings, the study identified seven key attributes for effective and efficient healthcare systems: equity, strong coordination of care, effective use of digitalization, investment in public health and prevention, efficient use of resources, clear governance and innovation.
"Our survey reveals remarkable global consensus around the basic principles that people expect from healthcare systems," said Thilo Kaltenbach, Partner at Roland Berger. "Against this backdrop, it becomes clear when we compare different countries that it is the healthcare systems that take these key factors seriously and are based upon them that are the most successful and resilient, and thus fit for the future."
While the message is clear when it comes to the public’s stance on socialised medicine, many healthcare systems around the world find themselves under growing strain because, according to Roland Berger, “the core assumptions underpinning them no longer match today’s realities”. With demographic change increasing the disease burden, and real-terms spending cuts seeing many systems under-resourced, health providers are tasked with doing more with less – and often face “reforms” from governments to keep them “responsive to the needs and preferences of their population”.
When it comes to dealing with rising costs, however, governments are also often out of step with how the population believe universal coverage can be preserved. The majority of people are against restricting access to healthcare or reducing the service level, while three-quarters advocate for better-funding preventive healthcare and disease prevention to bring down costs in the long-term. At the same time, just 24% would agree with insurance premiums increasing – while 58% support cutting “wasteful spending”.
In order to identify savings, healthcare governors often draft external consultants to draw up a plan – not at insignificant expense. The jury is still out on the value for money consultants provide in this space, and whether their fees might be a place healthcare systems could find some quick ways to save. But in this case, Roland Berger’s paper does not mention its own industry at all – instead, noting that the most robust public health systems focus on building their own capacity: “fostering coordination, driving digitalisation and insisting on stringent governance”.
The researchers noted, “We encourage [healthcare providers] to follow the recommendations of citizens to cut waste first before reducing service levels, and to replace costly treatments with more affordable alternatives, thereby broadening access to costly treatments where they are more effective. Further goals should include prioritizing outpatient over inpatient care, and digital self-service over outpatient care; reducing unnecessary prescriptions and implementing effective patient pathways; and using health data to drive research and innovation, while ensuring individual privacy. Finally, to reinforce equity, resources should be directed toward underserved groups, improving both access and outcomes.”
