Demand can have a profound impact on a PPP's effectiveness, profitability, and ultimately, sustainability. But while high levels of demand might be good for the economics of a toll road, they can be catastrophic for healthcare PPPs. With aging populations putting additional strain on already burdened healthcare systems, governments must seek to "narrow the funnel" of patients seeking care in the future. Without a significant reduction in demand, the more sensitive elements of healthcare systems will soon be overwhelmed-if they aren't already. Even today, this strain on supply manifests itself in long wait times for procedures and dispensation of medicine. Obviously, the key is not to restrict access to healthcare, but to reduce the demands placed on the system by an unhealthy population. Ultimately, reducing demand for healthcare services is a matter of prevention-making people healthier. But how should governments actually go about reducing demand? Singapore's Health Promotion Board provides a clarifying example.
CASE STUDY Singapore's Health Promotion Board Let's return once more to the Health Promotion Board. We've examined how Singapore was able to effectively modify market dynamics from the supply side, by engaging with food hawkers and producers. But improving healthcare outcomes is also dependent on demand-side interventions. Reducing demand for healthcare services was a huge priority for the HPB. As Professor Chia Kee Seng, founding dean of the National University of Singapore Saw Swee Hock School of Public Health, put it: "If we do not take care of the elderly issues of the future today, we will forever be behind the curve. You must go upstream to deal with the people who are young today." In order to effectively reduce demand for healthcare services, the Health Promotion Board would need to encourage healthy behaviors among its citizens, but how? Major NCD risk factors like smoking, consuming unhealthy foods, inactivity, and the harmful use of alcohol are all highly addictive-some more so than others. How could the HPB engage the population efficiently given the limited resources available to them, especially given the immense challenge of breaking these highly addictive habits? It was a tall order for any government. But for the HPB, the solution was contingent upon engaging an entirely new stakeholder in the PPP equation: the public. We will discuss in a few pages how the HPB used public engagement as a tool for reducing demand. |
And of course, the importance of "narrowing the funnel" has only become more apparent during the Covid-19 pandemic. Images of overwhelmed hospitals in northern Italy, parts of the United States, and around the world have dominated the news. Patients suffering from an NCD are more likely to experience hospitalization and death. And while PPPs have been deployed to expand healthcare capacity during the crisis, an equally valuable role for the private sector may lie in reducing the number of hospitalizations needed through prevention.