NHI needs a Holistic Approach: Dr Okore Okorafor Medi-Clinic health economist; Rev. Keith Vermeulen, public policy officer for SA Council of Churches; Craig Comrie Head of Business Development and Marketing Metropolitan Health; Tebogo Phadu Head of policy research council at the ANC; Kusile Mthunzi Hairwadzi Corporate Affairs Executive Metropolitan Health; Bongani Bingwa media personality and Engage Forum facilitator.
“While all stakeholders agree that universal healthcare coverage is a necessity for all South Africans, the means of achieving this are presenting challenges for both the private and the public sector.”
In South Africa, around R200 billion is spent annually on healthcare. R100 billion of that is spent by the 16% of the population that can afford medical coverage, while government spends the other R100 billion on the remaining 84% of the population. As much as 15% of the South African population, who are not medical schemes members also purchase from the private sector. These statistics were presented at the Engage Forum hosted by Metropolitan Health on 27 July 2011.
“This is unacceptable,” said Rev. Keith Vermeulen, public policy liaison officer for the SA Council of Churches, who was invited to speak at the Engage Forum, a bi-annual event that brings together a panel of experts to examine South Africa’s readiness for the inevitable changes that the NHI will bring. “We are failing to meet the Millennium Developmental Goals. The question is not can we afford the NHI, but can we afford not to go the route of a more efficient, effective and quality healthcare service that’s equitable for all?”
One of the areas that the panelists discussed was the potential for collaboration between government and the private sector. “South Africans do possess the specialised management skills necessary for a publicly administered and publicly funded NHI fund, but, when the time arises, they must make themselves available,” said Tebogo Phadu, who heads up the policy research council at the ANC. He also said that South Africa might call upon external (foreign) specialists who have successfully established NHI systems elsewhere.
By all accounts, the private sector is willing to engage with government, acknowledging not only the need for universal healthcare in South Africa, but also that their sector needs to evolve in order to remain relevant in the face of change.
“The private sector can assist in achieving universal coverage,” said Dr. Okore Okorafor, a health economist at Medi-Clinic. “For example, private hospitals can assist in the training of doctors and nurses. Also, private hospitals have well established quality control measures in place, which they can share with government, providing an interchange of ideas and access to research,” he said.
He did, however, raise the concern that with South Africa’s “narrow tax base”, it might not be possible for the public sector to provide comprehensive free healthcare at an acceptable level to both the wealthy and the poor. “There could possibly be an additional tier of ‘low-cost’ private healthcare,” he said. “The beauty of this is that it may cost government very little or nothing for this to work in South Africa.” He added that in a multi-tiered system, the benefits of taxes will be channeled to lower income groups, while the wealthier groups fund their health care services through medical scheme-type contributions.
Okorafor was adamant that government, in its stewardship role, needs to recognise the different and valid interests of other stakeholders in the health sector.
Phadu outlined the next steps in the process. “Government will release its policy on the NHI, introduce legislation and commence public discussion and debate,” he said. “Thereafter it is to be implemented in phases over the next 14 years.”
He also pointed out that NHI planning is an ongoing process that will be subjected to ongoing review, both during and after the passing of its legislation. In conclusion, he said, “The NHI is a part of a nation-building process. The challenges to the public and private sectors must be addressed. A constructive discussion around the goals, principles and functions of the NHI is what we should be focusing on. Let us build an NHI system we can all be proud of.”
Get the latest issue of FAnews