This year’s budget commentary held very little surprises from a medical scheme perspective. Fedhealth’s CEO Katy Caldis does however believe that the increase in public health expenditure is very positive considering there has not been any real growth in public health expenditure since 1996. Caldis believes that improved resourcing in the public sector is critical not only to improving health outcomes, but also to form the foundation towards the longer term goal of National Health Insurance (NHI).
On a positive note for those who have cover in the private sector, the budget allows for inflationary adjustments of the tax subsidies to allow for fiscal drag. This further reinforces the fact that there is a clear understanding from a government perspective that NHI is not something that can be implemented within a year or other unrealistically short time horizons. “We have more complex problems than other countries so I think we all realise it will take much longer to achieve a workable NHI,” she says.
South Africa is reeling from having one of the highest mortality rates at birth, both mother and child, as well as a very low life expectancy which is not very positive for a country that is already spending 8% of its GDP on healthcare. Part of the reason for this is that in South Africa we have a double burden of disease.
“In the developed section of the economy, we have the first-world diseases - all your lifestyles diseases such as hypertension and diabetes, but then we have the burden of HIV which is really one of the reasons we have such high infant mortality and low life expectancy ratio.” It is thus very encouraging to see a further allocation of R 3 billion on top of the R5.4 billion allocated in October for HIV and AIDS. Minister Gordhan says that there are “presently, about
920 000 people on anti-retroviral treatment. The budget provides for the number to rise to 2.1 million in 2012/13.”
The implementation of the budget is, however, the critical factor. Caldis believes it is imperative that it be spent in such a way that it lays a foundation for increased effectiveness and improved outcomes into the future. “There is a dire need to address the skills shortfall by training more doctors and nurses and possibly even importing these skills, particularly in the public sector where there is such a shortage.”
On the issue of closer partnerships between the public and private healthcare systems as a prerequisite for setting up an NHI, Caldis says it is important not to mix up political rhetoric with the reality on the ground. “Implementing an NHI system is extremely complex. It's a long-term solution and I believe it is encouraging that the current Minister of Health is quite understanding of the complexity of the rollout.”
The budget specifically highlights the intent of broadening the use of public private partnerships particularly in respect of improving the public hospital sector. Combining the public and private resources can go a long way to addressing this problem. “There is a great deal of expertise that sits within the private sector, so the key is going to be how those private/public partnerships work together. Knowledge transfer is key. For example, in the areas where the private sector is very strong, like in logistics, financial management, and management of hospitals, the public sector is particularly weak. Thus there must be synergies that can be leveraged , there needs to be a real meeting of the minds,” comments Caldis.
She says the Department of Health has had a ten point plan out to address these very outcomes and says a lot of the points in the plan speak to human resources and better management and strategic leadership. “So hopefully we will see these additional funds being used to rectify these issues so hospitals can have greater capacity in the long run. We will then have achieved success.”
“NHI is part of the ten point plan, but it's a longer term objective and it will provide all stakeholders with a chance for greater dialogue to find a really unique South African solution that is going to work and is going to retain all the resources we need in the country. Ultimately we all need to apply our minds to finding a solution where everybody in South Africa has universal coverage in whatever form that might take,” she concludes