Dr Moses Haregewoyn on the people health systems were built for — and keep failing

Health coverage and health access are not the same thing. This distinction - obvious when stated, consistently underweighted in practice - is the source of the most persistent and least discussed form of failure in modern public health systems. Governments expand coverage. Populations gain legal entitlement to care. And then the data returns showing that millions of enrolled members are not actually receiving the services their coverage entitles them to, because the administrative infrastructure connecting entitlement to access does not function reliably enough to close the gap.

This is the problem that Dr Moses Haregewoyn has built an institution to address. It is also the problem that Southeast Asia's expanding universal health coverage systems are only beginning to confront at full scale.

As President of Automated Health Systems (AHS), Dr Haregewoyn leads an organisation that operates as an administrative layer of public health access across effectively all fifty US states. AHS does not provide medical treatment. It administers the systems through which eligible citizens become covered members and through which covered members remain connected to the care their coverage entitles them to: eligibility determination, enrollment specialisation, managed care coordination, and the citizen support infrastructure that prevents coverage from lapsing through the kind of administrative failure that health policy documents rarely acknowledge and health governance conversations rarely reward.

The enrollment problem is a governance problem

Medicaid (Federal/State funded healthcare systems) eligibility in the United States is not a permanent status. It is subject to periodic redetermination - a process through which each enrolled member must re-establish eligibility, often annually, sometimes more frequently. During each cycle, there is a risk of administrative dropout: a form not received, a document not submitted, a deadline missed. Each instance of dropout represents a family losing coverage not because they are no longer eligible but because the administrative process did not reach them reliably enough to prevent the lapse.

"AHS is a national leader in the Medicaid space and we look forward to bringing our talent and expertise to help the people…" Dr Haregewoyn has said. The framing is purposeful: this work requires specific expertise, applied to specific populations, within a specific framework of government accountability. It is the operationally demanding, largely invisible work of keeping coverage connected to the people who depend on it - not as a policy commitment but as a daily administrative reality.

The organisation's performance in this space has drawn recognition at the federal level. In 2022, the United States House Energy and Commerce Committee, exercising its oversight responsibility for Medicaid and CHIP administration, formally contacted AHS regarding its participation in states' plans for managing post-pandemic eligibility redeterminations - a process that affected tens of millions of Americans and that AHS was considered a significant enough operator to warrant direct congressional inquiry. That recognition is a different kind of credential than any institutional award.

What Southeast Asia faces

Indonesia's Jaminan Kesehatan Nasional, the Philippines' PhilHealth, and Thailand's Universal Coverage Scheme have each achieved coverage rates that represent genuine policy accomplishments. Each also faces the challenge that aggregate enrollment figures conceal: that the populations most recently added to coverage rolls - informal-sector workers, migrant communities, rural populations - are disproportionately likely to experience the administrative vulnerabilities that convert enrollment into dropout. Mobility creates documentation gaps. Language barriers reduce navigation capacity. Unfamiliarity with formal processes means that redetermination cycles, however well-designed, lose people who should remain covered.

These are the conditions that Dr Haregewoyn has spent his career learning to administer around. His academic formation across organisational behaviour, public health, and sociology informs an approach that treats the social and economic circumstances of the population being served as design inputs - not complications to be managed around but constraints to be designed for. The eligibility systems, outreach models, and support infrastructure that AHS has developed under government accountability across the American federal health landscape represent a knowledge base developed under conditions closely parallel to those now facing health administrators in the Indo-Pacific.

The invisible layer

Policy analysts studying health systems in the region have identified a consistent finding: the most significant barrier to sustained coverage is not treatment capacity. It is the administrative capacity to keep people enrolled. The infrastructure required to address that barrier - digitised eligibility systems, multilingual outreach, trained administrative staff, and measurable performance accountability - is not an implementation detail. It is the foundation on which everything else depends.

Dr Haregewoyn has spent 30 years building that foundation, refining it under verifiable conditions, and demonstrating that it is possible to serve the populations that health systems find hardest to reach - reliably, at scale, and with the kind of accountability that government partners require. That body of work is the argument for his standing in the international conversation about what health governance requires next.

This article is brought to you by Automated Health Systems.