Plans to roll out national health insurance should not be seen as a declaration of war on the private health sector, but an attempt to design a system that works, using existing resources, to provide affordable care for all.
Announcing Friday’s release for public comment of the green paper that spells out broad policy proposals for the scheme, Health Minister Aaron Motsoaledi said: “The NHI is not a war between the public and private health care sectors – it’s not even a competition between these two health care delivery systems.
“If we view matters in this light, and try to tear each other apart, the people will be the real losers.”
Pilot projects would be launched in 10 districts in April, the start of what Motsoaledi calls a crucial five years in which the management, staffing, infrastructure and equipment at public facilities would be overhauled and an NHI fund set up. The entire roll-out would be phased in over 14 years. Motsoaledi said the first five years would be the “most complex”.
Establishing a NHI service was agreed on at the ANC’s 2007 Polokwane congress, and President Jacob Zuma’s administration is under pressure to deliver amid mounting public dissatisfaction with the ailing public system.
Questions about the NHI’s costs were referred to Finance Minister Pravin Gordhan.
He said the R125 billion price tag mooted for the first year – and cited in the green paper – was only “indicative” as “a linear projection of what it will cost once the pilot projects are under way”.
“There’s money in the system at the moment,” Gordhan said. The details would have to be “worked out” during the pilot period.
There were many ways of rationalising costs, he said.
Infrastructure projects would include six new referral hospitals, Motsoaledi said, and would cost “more than the 2010 World Cup stadiums”.
Putting “the right people in the right places” would be crucial.
Motsoaledi said he would soon announce the country’s first health human development strategy “that will show clearly who needs to be where and how they are going to be trained” – including doctors, nurses, pharmacists and allied health professionals.
Hospitals would be redesignated as district, regional, tertiary, central or special – for treating tuberculosis, for example – in a uniform system, with the employment of managers who had the correct qualifications, for appropriate pay.
Motsoaledi said one of the reasons for the poor quality of public health care was that “anyone can wake up and think they want to run a hospital”.
“That’s one of the things we have to change if we want a good health care system,” he said.
South Africa spent 8.6 percent of its gross domestic product on health – far beyond the 5 percent recommended by the World Health Organisation – an average of R2 700 a person a year.
That health outcomes were so poor showed there was something very wrong with the system.
The quality of care in public health facilities was “often totally unacceptable”, and “radical measures” were needed to correct this.
“But we need to appreciate the sheer scale of the service provided by public health facilities in ensuring care for 84 percent of our people who totally depend on these facilities.
“In many cases this involves a heroic effort day in and day out by men and women in our hospitals under very trying conditions.”
While the private sector was held up as an example of good service and quality care, the price tag that came with this was “not only a burden to people using private health services, but a disservice to our country as a whole because it distorts pricing across the board”. There were clear signs that this might, in the long term, be unsustainable, Motsoaledi said.
The challenge was to get the best out of both systems. “(With) this green paper on NHI we’re making a real effort to design a system that works with the resources we have and build on these.” Even if it was affordable, extending the current model of private care to all citizens would overwhelm the sector.
“The bulk of South Africa’s health infrastructure resides in the public sector and our task is to overhaul it so that people will choose to go to public facilities once they have options.”
While this might sound impossible, it could be done, Motsoaledi said. Not too long ago, public hospitals were an automatic choice for people who could afford private care.
Achieving NHI would be a “long journey” and “at times things will be tough”, Motsoaledi cautioned.
For the scheme to be viable, the quality of service at public sector facilities had to be improved. Private health care pricing had to be tackled equally seriously. - Political Bureau