Driving the quality and scale of healthcare services

by Isabel Rodrigues

Article published in Envolverde Magazine, from Carta Capital

With each election, society renews its hope that the future government will solve, or at least address, complex social problems such as crime reduction, education and health. Every year, billions of reais are allocated to social policies in these areas. However, in the absence of clear indicators of effectiveness, it is difficult to monitor the success of such programs, leaving the State heavily exposed to the financial risk of failure of its policies and programs.

Given their complexity, such problems require the collaboration of different actors and the opportunities for this collaboration are often limited by the pre-established structures of public procurement. However, there are already public action instruments around the world that allow the incorporation of new actors in the solution of public issues, such as Social Impact Bonds, which allow for this collaboration within existing rules.

The Social Impact Contract (CIS) is a new payment mechanism for social results, through public contracting of private investments for the execution of social services. This mechanism links the financial return to the achievement of positive social results: the statebg-principalpromises to pay investors, with a rate of return, only if the goals established for a defined population are reached. In this way, the financial risk of program failure is assumed by the investor, removing the burden of ineffective solutions from the public sector.

In general, health services seek a form of financing that encourages the investment of resources that provide both benefits to the health of patients and a return on this investment to society. Between 2010 and 2017, were launched 18 contracts in the health area around the world, addressing topics such as social isolation, mental disorders and diabetes, mobilizing more than 90 million of dollars[i] and impacting more than 650,000 individuals. In addition, twelve contracts are being developed within the health theme in several countries.

The first health-focused CIS was launched in Newcastle, England in 2015. Government data showed that over 15 million people in the UK suffer from chronic health conditions such as diabetes, asthma and heart disease, representing 70% spending on the national health system[ii]. Through the ?Ways of Wellness?[iii], the CIS aimed at the management of chronic diseases by patients through non-medical interventions, providing changes in lifestyle and improvements in well-being. Four non-profit organizations were responsible for providing such interventions, which included physical activity, social interaction, healthy eating and cooking, with ongoing support from employees.

From April 2015 to March 2017, over 2400 people had participated in the program. More than 800 patients, who completed program assessments to measure their change in well-being since the service began[iv], reported that their well-being improved by an average of 3.5 points, on a scale of one to five, being able to manage their lives quite satisfactorily. The program also achieved 90% positive responses in a general practitioner staff satisfaction survey.

Already with a preventive character, Canada launched, in 2016, its first CIS focused on reducing the probability of developing hypertension. About six million Canadians have hypertension and another six million are pre-hypertensive. Estimates indicate that costs attributable to hypertension will increase by 47% between 2010 and 2020[v]. With the intention of reversing this scenario, the Public Health Agency of the country launched, through the CIS, the Community Initiative for the Prevention of Hypertension, a new health program aimed at increasing awareness and prevention of the disease among the populations of Toronto and Vancouver. Through local partnerships, the program supports healthier lifestyles in order to reduce the onset and development of hypertension, with tools and free support to improve nutrition and physical conditioning.

Even more than England and Canada, Brazil faces challenges in the health area that would benefit from successful social interventions, thus representing a fertile field for contracts for social results. In addition to advancing one of the UN's 17 Sustainable Development Goals, an innovative model of social investment such as the CIS allows barriers between government, civil society, service providers and investors to be broken down, attracting new investments and generating improved health. for the population, cost reduction for the government and return for the investor.


[i] http://sibdatabase.socialfinance.org.uk/

[ii] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216528/dh_134486.pdf

[iii] http://waystowellness.org.uk/

[iv] Measurement carried out through the Well-Bring Star, designed for people living with chronic health conditions, to support and measure their progress in life for as long as possible. http://www.outcomesstar.org.uk/well-being-star/

[v] https://www.ncbi.nlm.nih.gov/pubmed/26169049; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4368927/

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