Health care for transforms at snail’s pace

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Independent Newspapers.

Health Minister Aaron Motsoaledi takes a breather while briefing the portfolio committee on health in October last year. His National Health Insurance pilot schemes are having teething problems. Picture: Cindy Waxa.

A woman’s appendix ruptured while she waited for emergency surgery at the Mitchells Plain hospital in Cape Town last year.

A 69-year-old former matron of Jubilee district hospital in Pretoria died barely five hours after the same hospital sent her home with a “swollen” heart, classified as a critical patient. A man died when he was turned away by the Newcastle provincial hospital while in a state requiring emergency care.

These are some of the events that took place in 2013, demonstrating the plight of the poor when it comes to accessing health care.

Patients in some of the country’s largest public hospitals, including Groote Schuur in Cape Town and Edendale in Pietermaritzburg, admit patients without even having beds available for them.

In contrast, the country’s largest private hospital groups have reported occupancy rates of between 65 and 75 percent in the past few years.

In the period to September 2013, Mediclinic reported a 72.3 percent occupancy rate, Life Healthcare said 71.7 percent of beds were filled while Netcare hospitals had an occupancy rate of 67.4 percent.

But it is known to everyone who has been paying attention to National Health Insurance (NHI) developments that the private sector covers roughly 16 percent to 20 percent of the population. The remaining 80 percent is able to access care only at public hospitals and clinics because of the high costs in the private sector.

A recent research note published by Econex last month showed that about half of the national health expenditure in South Africa went to the private health-care sector.

But it also showed an improvement in the split of health-care coverage between the public and private sector, with the latter providing primary health-care services to an estimated 28 percent to 38 percent of the population in 2012.

The giant move to transform the landscape of the health sector was the gazetting of the NHI Green Paper in 2011, setting out the features of a policy that will facilitate universal coverage. NHI pilot schemes began last year, but the pace at which this policy is progressing has been criticised.

“As at the end of last year, we are still waiting for the promised NHI financing paper by the National Treasury, as well as the NHI White Paper,” said Mariné Erasmus, a health economist at Econex.

Health regulatory bodies and economists all agree that no significant developments in the health sector landscape were undertaken last year.

Every year conferences take place, and seminars and roundtable discussions are held to discuss universal access to health care. The government and the industry acknowledge universal access will come about only once the issue of escalating costs in the private sector is dealt with.

But as Health Minister Aaron Motsoaledi said at the Board of Healthcare Funders (BHF) conference in 2012, after all the gatherings and discussions, when people go back to their daily lives, nothing changes.

But Council for Medical Schemes (CMS) chief executive Monwabisi Gantsho said in an interview with Business Report that solutions and discussions could only continue once the Competition Commission had finalised its pricing inquiry and acceptable recommendations were implemented.

“It will be useful if the CMS can be empowered to extract critical information on costing from the regulated supply side of the health-care delivery system. The CMS is currently at an early stage of developing a comprehensive beneficiaries registry that can be populated by this data to tackle the escalating health-care costs in the private sector,” Gantsho said.

Arguably this data could be useful in the Competition Commission’s inquiry into the health sector, which is planned to start on Monday and be completed at the end of November 2015.

Erasmus said the release of the terms of reference for the inquiry was the most important event in 2013 as far as stakeholders were concerned.

The industry considers the final terms, gazetted at the end of November, as being much more comprehensive, better structured and giving more details on the scope of the inquiry than the original draft proposals.

This year the Medical Schemes Amendment Bill is expected to go through the parliamentary process. After a participative consultation process and public comment gathering, it will be introduced to Parliament and, if approved by the cabinet, signed into law.

However, the CMS has indicated that even though the bill was submitted to Motsoaledi in October last year, it was unlikely to come into effect before the end of 2015.

The bill is an important development because the medical schemes industry has seen no regulatory reform since 2003.

So 2014 should be the year in which some of the factors that have had a distortive impact on the health sector’s competitiveness should be identified.

However, Christoff Raath, the chief executive of The Health Monitor Company, forecast at the BHF conference in August that it would take about five years to resolve the issue of high costs through the market inquiry. But at least some hope that there will be some scope to put to bed all the finger pointing and blame shifting that has affected the industry in the past few years.

Another shake-up in the industry is expected when BusaMed, one of South Africa’s first black-owned health-care groups, in which the National Empowerment Fund holds a 49 percent stake, opens its new hospitals. The company’s equity raiser, Standard Bank, announced last month that BusaMed had secured R1 billion to build four new private hospitals in the Western Cape, Free State and Gauteng.

The group had also obtained licences to develop three more private hospitals in Harrismith, Johannesburg and Bloemfontein.


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