The value of partnerships for healthcare financing: 5 lessons learned

• Established best practices and the current global momentum can help effective multilateral collaborations build sustainable healthcare funding and financing models
• Shared goals, measurable impact, local ownership, and adaptability are key for health financing initiatives to succeed
• It is important that stakeholders be vocal about the different ways they can contribute and partner toward innovative, impactful financing solutions

It is well-known that an immense funding gap remains – estimated at USD 371 billion per year – for the world to make meaningful progress towards the health-related Sustainable Development Goal (SDG) targets by 2030.¹ Although global spending on health is growing, the pace is still insufficient.² Expansion of universal health coverage (UHC) is stalling and financial protection is worsening, not only in emerging markets.³

As recognized by the SDG 17, multilateral partnerships are required to drive sustainable change in healthcare.⁴ Calls for action from the public and global health communities have multiplied, urging the public and private sectors to find new ways to work together to ensure that everyone can access the care they need without suffering financial hardship. In response, innovative funding and financing mechanisms have emerged to accelerate the participation of the private sector to help raise and make more efficient use of funding for healthcare systems.

By bringing together diverse partners and harnessing the power of data and technology, non-traditional financing mechanisms can complement traditional funding sources like general taxation or compulsory insurance contributions. They include:⁵

• Point-of-care financing models: New credit services, installment payment – for example performance-based, mobile wallets
• Multi-source crowdfunding: Fundraising, mutual aid funds, donations 
• Novel private insurance: Inclusive insurance, wellness-driven insurance, public-private insurance schemes
• Blended finance: Public-private catalytic funding, impact and results-based investing such as bonds
• Public funding: New taxation channels, multi-party contribution funds, managed-entry agreements

Building on more than a decade of experience, the healthcare industry has shown it can contribute to developing and implementing methods of financing healthcare.⁵ There are key lessons that we can take forward, and now more than ever, there is an urgent need to build sustainable collaboration between the public and private sectors.

When we look at the task at hand, it’s easy to get discouraged. More than half of the world’s population still does not have full access to essential health services. In 2021, more than 1.3 billion people were pushed or pushed further into poverty by out-of-pocket payments (and this does not include people who forego care altogether).³ These numbers are not really improving, and in many countries, they are getting worse. For the private sector, efforts may often feel like they are just a drop in the ocean.

This may be true at first, but if the idea is good and the initial project succeeds in delivering some impact, one drop can ripple, grow, and become a wave.

As an example, in 2010, Roche started collaborating with Swiss Re and local insurers as part of a pilot program in China to develop cancer insurance coverage policies that could provide adequate coverage at an affordable cost. Bringing together the pharma and insurance industries’ expertise and data to address critical financial protection gaps, despite very different (even conflicting) business models, turned out to be successful. The pilot was scaled up and millions of people were given comprehensive cancer insurance coverage. The collaboration continued to expand in China, including partnerships with provincial governments and inspired similar projects in other Asian countries.⁶

Roche and other biotech companies like MSD or Pfizer have continued to work with the insurance industry worldwide, for multiple diseases and population segments. New collaboration models have emerged and in many countries, there is ongoing multilateral dialogue with governments to define a more coordinated role for supplementary health insurance to facilitate access to innovative care.

Not all of this success, of course, should be directly attributed to the initial Roche-Swiss Re collaboration in China. However, over the past decade, the work of engaging multiple partners, publications, and public discussions (still mentioned at events today) has merged into a broader dialogue around the role that private insurance, together with the healthcare industry, can play in supporting UHC efforts.⁷ Similar ripple effects can be observed in other health financing areas. Projects that start small can drive or support meaningful changes in the long term.

Partnerships should be built on a well-defined value proposition and business or investment case for each party, along with clear goals, and specific targets and metrics. It may sound obvious, but too often mutual benefits are not clearly spelled out from the start.

Partners typically come together with a shared ambition, such as reducing the out-of-pocket burden for a target population, possibly a target disease area. This ambition is clearly commendable. But the win for each party will vary. Is it a short-term direct business impact (for the healthcare provider, the financial institution, or the distributor for example)? Or is it a long-term impact where the party invests resources – financial or human – to foster a better environment to thrive in tomorrow (for the biotech or medtech partner, the private investor, or the government for example)? Either way, can it be quantified? It should.

The need to quantify and then later measure the benefit for each party is often overshadowed by the interest in working together simply because the parties share a common agenda and have complementary capabilities. They may see the solution before they specifically define what they are solving for, leading to an unclear and consequently inefficient goal. Unfortunately, impact that cannot be quantified will soon enough be deprioritized, before the partnership even materializes or soon after.

Partnerships and collaborations that succeed in scaling up are usually those with clear targets that can measure the impact of the collaboration on populations and the return on investment for each party, whether public or private. Such metrics are critical to further demonstrate that investing in health leads to socio-economic growth overall.^8,9

Need and demand are two different things. For innovative funding and financing models to succeed, local ownership is key and it is absolutely crucial to work with local partners and understand from the outset how local customers, patients, and other stakeholders may respond to the program.

For example, in November 2023, Kenyan insurer APA, the International Finance Corporation (IFC), and the Yubuntu consortium (a consortium that brings together international organizations and the insurance and pharma industries) launched APA SHEild which increases access to affordable financial products for women in Kenya.¹⁰ APA SHEild includes an innovative cancer insurance policy, Femina Plus, that combines access to breast and cervical screenings for all insured with a payout in case of diagnosis. 

Femina Plus addresses a clear need and opportunity since women face particular challenges accessing healthcare.^11,12 Recent research also demonstrates that investing in women’s health makes financial sense, with the potential to boost the global economy by USD 1 trillion annually by 2040.¹³

Yet, some corporate customers in Kenya kept asking: “but, what about my male employees?”

Such a question doesn’t mean that there has been a failure, but it does mean there is something to learn. A good solution to an important population health issue does not necessarily result in large, immediate demand. The ability to adapt is the key. Cultural, social, and economic conditions, political agendas, as well as financial and insurance literacy all heavily influence whether or not initiatives will succeed.

Global initiatives best work if they support local organizations with viable models tailored to local needs, using global funds and new financing mechanisms. Two examples that illustrate success are the public-private platform SCBF¹⁴, which funds local inclusive finance organizations targeting vulnerable populations, and the MSD For Mothers¹⁵ initiative which supports local programs and organizations for maternal health. Both have reached millions of people by investing locally.

There is no simple recipe that will ensure that innovative funding and financing models are scalable and sustainable for patients, governments, payers, and the private sector. We have, however, a powerful opportunity to learn and build on experiences from the past 15 years. While there are certainly new models to be explored, there is also a need to reinforce existing programs or simply replicate successful ones.

In addition to mutually beneficial partnerships and locally-driven solutions, there are established factors that enable multi-stakeholder collaborations and successful funding and financing models. They include:

• Availability of data: Financing models should be based on reliable, effective data, and evidence of the feasibility, the investment case, impact, and outcomes. Data supports the development of results-based healthcare financing and more sustainable data-driven ecosystems that measure patient and financial outcomes, optimize resource allocation, and identify further opportunities.
• Technology: Digital technology helps make innovative funding and financing models more efficient. Fintech models such as mobile money have the potential to scale up to more population segments in a cost-efficient way. Health technology that brings preventive care, screening, diagnostic, or disease monitoring closer to where people live helps remove delivery and capacity barriers, also at a lower cost.
• Simplicity: It’s easy for innovative models to fall into the trap of complexity, as they mobilize diverse capabilities and must fit within an existing financing system. Partners should make the model as simple, user-friendly, and cost-effective as possible.
• Forward planning: Pilots should already know where they are heading before they start. It’s a difficult balance, but models that only focus on a niche or very targeted population segment to test a new idea may not work well beyond the pilot phase. In other words, it’s ok to start small as long as your model has the potential to work on a larger scale.

As traditional players work with new types of stakeholders (e.g. technology providers, private equity) on the healthcare financial protection gap, it won’t always be easy to understand the roles each stakeholder should play in reaching shared goals. The many different ways that each partner can contribute to building sustainable healthcare and financing solutions are not always clear. Since the landscape is rapidly evolving, it is important for stakeholders to be vocal about their capacities. Open and active communication will open up new opportunities to overcome barriers and develop new solutions across economies worldwide.

Here are some of the roles that the healthcare industry can play:

• Catalyst: Bring together stakeholders to identify and prioritize gaps and opportunities for new funding and financing models.
• Facilitator: Provide means and opportunities for stakeholders to discuss, agree, and implement new funding and financing schemes.
• Participant: Play an active role in funding and financing models by leveraging your own business model, experience, and expertise. This means not only supporting or providing access schemes on treatments and technologies included in the program but also providing data and insights to make the program affordable and sustainable. Or, where appropriate, contribute financially as a sponsor, donor, or investor.
• Champion: Communicate lessons learned from funding and financing solutions that have been implemented in different regions/places and with different stakeholders to inform the development of future schemes in healthcare.

Innovative funding and financing models can play a complementary role as governments necessarily increase investment in healthcare. Multiple funding and financing mechanisms can exist within each health system, as they address the different needs of different populations.

With its scientific and business expertise, global footprint, in-depth understanding of local health systems, and continuum of care and resources, the healthcare industry has a pivotal role to play in sustainable health financing. The collaborative models and platforms that have emerged in recent years demonstrate the power of multilateral collaborations, and there is value for all actors to get involved.

Standing on the trials and successes of the last two decades, there is currently a great deal of momentum for cross-sectoral collaborations and more sustainable healthcare financing solutions.  By harmonizing public-private sector goals, measuring the societal, economic, and financial return on investing in health, leveraging diverse capabilities, and harnessing data and technology, we have the power to make real breakthroughs in financing healthcare for much of the globe.