NATIONAL HEALTHCARE REFORMS

We all know that nothing is as certain as change, and the press has in recent months contained many reports on the ruling party’s healthcare proposals.  But what exactly are these, and how will they affect each of us?

Proposals to ‘reform’ healthcare in SA are nothing new. The word ‘reform’ itself should not be interpreted to mean that our entire system is in need of reform – in fact, only certain parts are.   Not so long ago there were proposals to levy special income taxes on all taxpayers to fund a “free” national healthcare system.  Again, the word ‘free’ is misleading, since all healthcare comes at a cost. These proposals came to naught.

Now certain spokesmen are again making pronouncements which might lead one to believe that the entire healthcare system will be replaced by a State run system, and this will happen during the current administration’s term of office. The fact of the matter is that out of the total expenditure on healthcare, some 42% is funded by medical schemes, some 43% by the State (ie the taxpayer) and some 10% by out-of-pocket payments by citizens who do not wish to use public hospitals but are not members of medical schemes. To imply that private healthcare is the cause of poor public healthcare delivery is to misrepresent the true position.

One of the major problems with our State healthcare facilities is historical. From 1998 to 2002 promotion to higher grades in the public health sector became automatic, without reference to performance appraisals. Suddenly the salary bill rocketed. The budgets, however, stayed the same, leading to fewer people being employed, albeit at higher salaries. The budgets have since been increased, but skills improvement leaves much to be desired. To make matters worse, the amount of money allocated to healthcare is decided by the provincial authorities, not by national government, a practice which creates different standards in different areas.

One of the suggestions is that unlimited visits to GPs should be included in the new system.
In the UK health system, which is well funded, it takes 3 days to schedule a visit to a GP and about 2 weeks to get to see a specialist.  As a result, many people prefer to pay for these lower cost items out of their own pockets.  Already South Africans of all income levels are finding that they are prepared to fund GP costs themselves.  To promise to include immediate access to GPs in any new system is simply revealing one’s lack of understanding of the realities of the situation. It won’t happen, leaving a lot of disillusioned patients.

If the government is unable to fix the present public health system, why, it is asked, does it believe a new public health system will succeed?  The basics of any new system will not change materially from the present one.  There needs to be a workforce strategy (there is none at present); The health outcomes are poor ( why should this change if there is a lack of qualified personnel?); there is insufficient information on the system to allow data gathering for strategic decision making; there are few relationships with the private providers.

The private sector also needs improving:  cost increases often exclude low income earners; risk equalization is not being implemented despite legislation requiring it, and governance reforms are lacking.  But at least sick people tend to get well within a reasonable time.  With the SA life expectancy now averaging 47 years, those who visit the State facilities are getting little value for our current healthcare spend.  If only basic things like clean water could be provided and basic hygiene could be practiced, the general level of health would improve. There is a lack of clear vision on many of the basic diagnostics.

In the rest of the world, systems regulated by the State but run by private enterprise have worked best.  The public healthcare system needs reforms first, but whether the current administration has the political will to achieve this is another matter. 

It is likely that the debate on a new system will continue for some time, given the need for all parties to gain an understanding of the fundamentals of healthcare in SA, and given the fact that that Treasury is short of many billions of rands and simply cannot afford to spend money on untested healthcare systems which look unlikely to succeed.

Clive Hill | Financial Services Manager

(with acknowledgment to A. van den Heaver, healthcare specialist, from whose research and opinions much of this article was constructed).