Motsoaledi calls for 're-engineering' of healthcare system

The Minister of Health, Dr Aaron Motsoaledi, has hit out at the “deadly divide” in South Africa's healthcare system, saying that the structure we have now is worse than what existed during apartheid.

He was the keynote speaker on the opening day of the Board of Healthcare Funders' conference, aptly titled The Turning Point, which is currently underway at Sun City. The conference has attracted over 900 local and international delegates from the healthcare industry, including healthcare professionals, policy makers and regulators.

“There is a tendency to believe that a long and healthy life is the right of those that can afford it, and that is totally wrong,” the Minister said. “The reality is that our people are dying in large numbers.

We are running a healthcare system in this country that is not working.”

The solution, according to the minister, lies in re-engineering the country's primary healthcare system. He announced a plan to introduce three streams of care which will have a particular impact in rural areas.

• The first is the provision of specialists in each of the rural district municipalities. These positions will be announced by the end of July, and if the posts are not filled, the minister has received an undertaking from all the medical schools in the country to fill the posts from among their own staff on a year-long rotational basis.
• The second is the establishment of a school health programme. “We have 12 million learners and no one taking care of their eyesight and hearing. Drugs and teen pregnancies are running rampant, while we wait for them at the hospital. I want to see nurses in every school, and we will call on the help of retired nurses if necessary.
• The third is the provision of primary healthcare workers in every municipality. The success of a pilot project in KwaZulu-Natal has led to plans to roll the system out to every municipality in the country.

Minister Motsoaledi accused both the public and private health sectors of “engaging in destructive, unsustainable practices”. He was particularly outspoken about the high cost of private hospital treatment, and called for a stronger emphasis on primary care, rather than the present curative system with its “rapidly escalating” costs.

“The public health system is in a crisis of quality and I am going to deal with it head on, but it is not an excuse for profiteering,” he said.

“Our country is going in the wrong direction... all of us, public and private,” he said. “We have a predatory healthcare system where the sick and the vulnerable are the ones who get attacked.”

As an example, he referred to the cost of circumcision, a prcedure which he described as “the simplest of all”.

“I cannot be convinced that this must cost R15 000 per procedure,” he said, telling delegates of his own experience of performing as many as 10 circumcisions in two hours. His concern is that as circumcision becomes the policy of government it will be unaffordable. The procedure has been proven to play a part in lowering the transmission of HIV.

The minister's cost estimation has been challenged by the hospitals, but their accuracy is undeniable as they are based on figures which were provided to his department by BHF members.

The minister laid part of the blame for price hikes on the Competition Commission's ruling of 2004 which gave healthcare providers the loophole to charge excessive fees. He said that he did not see regulation as the only answer to the country's woes, but was in the process of establishing an Office of Compliance which would include an inspectorate, an ombudsman and an accreditation division.

He told delegates that their concerns over Prescribed Minimum Benefits were “zama zama – you are trying your luck. You are trying to paper over the cracks. Whoever wins, it will not change the system at all. The crux of the issue is to look at what costs what, and is it realistic”.

He revealed that his Department had completed its preparatory map of the health system. The 18-month exercise has resulted in a clear view of the state of every healthcare facility in South Africa. This exercise was a vital step, he said, and will provide the basis for the NHI strategy document which is expected to be finalised by late August.

The minister made it clear that his department was not wanting to abolish medical aids, but was keen to work with the private sector to address the challenges.

In conclusion, the minister tasked the private healthcare industry to:

• Provide benefit packages that include promotive and preventative healthcare, not just high cost curative care;
• Improve reimbursement to the public healthcare sector for services rendered to medical scheme members through a simplified claims submission procedure;
• Reduce non healthcare costs to below 10%;
• Strengthen governance in medical schemes and administration;
• Simplify benefit packages; and
• Introduce alternative reimbursement systems such as capitation which will reduce costs and end over servicing.

In closing, Dr Clarence Mini, chairman of the BHF commented that the apt title of the conference was an indication of the commitment of conference delegates to continue to examine the concerns and issues that the minister addressed and to find workable solutions to the challenges he had raised.