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Private-Sector Engagement: Two Modalities

The Insurance Industry

The private insurance industry exists in some countries as a supplement to government-underwritten care and in others as the primary mechanism for bearing the costs of healthcare. In both cases, its purpose is simple: to spread the financial risks of expensive healthcare across large populations. Because insurance companies are highly motivated to attenuate risk among their customers, their interests are very closely aligned with those of the public sector. Simply put, healthy behaviors can reduce costs for insurance companies, thereby increasing profit margins. This creates an opportunity for partnership.

In fact, many insurance companies have enacted rules and regulations to encourage healthier behavior among their customers: premiums are generally higher for smokers, or those with high blood pressure, for example. These kinds of tools can be helpful, to an extent. In many cases, however, their effect is limited. After all, while a 20% increase in one's insurance premium each year might seem at first like a profound motivator to stop smoking, it pales in comparison to the sheer addictiveness of tobacco. Still, tools like these can still be helpful in managing NCDs and "narrowing the funnel" for healthcare services, a concept we will discuss later in this chapter.

By partnering with governments (through convenings, negotiation, and eventually full-fledged PPPs) insurance companies could help engage the public in solutions, encourage better habits, and reduce NCD risk factors. Insurance should be considered an "aligned" industry.

Digital Health and Technology

Technology also has the potential to increase efficiency, encourage healthy habits, and optimize outcomes on a massive scale. The opportunities for partnership within the technology sector are myriad, and there exists much untapped potential.

Companies that produce digital fitness tools, for example, are highly aligned with the interests of governments. The potential of digital health tools to engage the public as a partner in encouraging positive changes in behavior cannot be overstated. In August 2019, for example, Singapore's Health Promotion Board announced a new partnership with the American fitness wearable brand Fitbit to give away one million digital fitness trackers.43 This move will almost certainly result in improvements to physical fitness, not to mention an increasingly detailed picture of Singapore's relevant health data. Seeing value for both the government and for Fitbit, the HPB was able to include digital technology as one piece of a larger strategy to encourage healthy behaviors. (We will discuss Singapore's strategy in more detail in a few pages.)

Technology could also play a significant role in increasing efficiency within existing healthcare structures, and for regulators. Healthcare systems generate massive amounts of data. Through effective management of this data through technology, healthcare services can be optimized and costs can be reduced. But even in 2020, many in the healthcare sector are still using paper records, limiting the transfer of information across the healthcare system and creating inefficiencies and redundancies. The effective engagement of the technology sector in managing data could provide significantly improved healthcare outcomes. And yet, resistance to innovations that depend primarily on technology is common among Ministries of Health and other healthcare-facing parts of government.

This resistance has traditionally stemmed from three concerns: value for money, job security, and privacy. Governments, skeptical of technological solutions sold to them by tech firms, are unlikely to support a costly overhaul of healthcare data systems without sufficient evidence that the overhaul would result in significant cost savings or improved outcomes. Furthermore, governments also have a responsibility to the workers employed in existing healthcare systems. And of course, the intersection of data-based technology companies and healthcare also raises significant privacy concerns. How much should the private sector (or the government) know about a citizen's health history, their workout regimen, or their diet? Even if comprehensive data analysis can produce better healthcare outcomes, the question of privacy remains.

However, resistance to technology is waning. Through effective convenings, and using the engagement strategies of negotiation, political management, and innovation, governments can work with the private sector to develop effective, affordable healthcare solutions that maintain strong standards for data privacy. If properly managed, strong private-sector engagement can also pursue the transferral of knowledge to benefit employees in the government and healthcare structures, ensuring that workers share in the benefits of technological advancement.