As countries grow wealthier, models of healthcare provision and financing need to adapt to increasing expectations and new demands for healthcare. In many countries, there is growing interest in developing affordable universal health coverage. While this will bring important benefits it also creates challenges.

Over the past ten years, there has been an unprecedented growth globally in the number of people rising out of poverty to achieve middle-class status. This population, often referred to as the middle-of-the pyramid (MOP), has a significant disposable income meaning an increasing demand for healthcare. The question of how to meet the increasing demands and expectations of a growing MOP population is a huge challenge for both the financing and provision side of health care.

This report explores these questions and to answer them we have searched the literature, collected case studies and commissioned research. We brought together experts, hospital managers, payers and policy makers at a KPMG client conference in Johannesburg. Over 70 KPMG Clients and healthcare leaders met for two days where we tested our ideas, challenged assumptions and learned from each other.

This report looks at the components required to build low cost high quality health care system. It tackles how these components come together into a complete, affordable health system and identifies what actions can be taken to ensure the aspirations of the emerging more affluent populations can be met without weakening the wider health system and adversely impacting the poor.

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Low cost & high quality care at scale 

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