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The state of the nation’s health: The challenges of proving affordable, effective access to healthcare in South Africa

03 March 2010 Pro Sano Medical Scheme
Dr James Arens, Clinical Operations Executive, Pro Sano Medical Scheme

Dr James Arens, Clinical Operations Executive, Pro Sano Medical Scheme

The healthcare industry in South Africa, both public and private, presents a major challenge for the health authorities and the population at large. Although at face value the private healthcare sector seems to have its ducks in a row, in reality it is an extremely inefficient system that contributes little to addressing the broader concerns of the country.

The private healthcare sector is also notorious for its failure to curb the run-away medical inflation that we are currently facing. This is largely because of the set-up where profit-driven private hospitals and practitioners draw their income from not-for-profit heavily regulated medical schemes. Another anomaly in this industry is that the very same profit-driven service providers drive the demand for health, through their expertise and decision-making powers.

The public healthcare sector, on the other hand, has limited financial resources in the face of an ever-increasing burden of communicable and lifestyle diseases. The recent Henry Kaiser Foundation discussion document titled ‘An Overview of Health and Healthcare in South Africa 1994-2010’ summarises the country’s healthcare challenges as stemming from:

  • inefficiency in the prevention and control of epidemics (HIV and AIDS (please note this is now the required way of writing this) and Multi Drug-Resistant TB)
  • persistently skewed allocation of resources between the public and private sectors (financial and human resources)
  • weakness in health systems management (including poor quality of care and operational inefficiencies).

The current minister of health, Dr Aaron Motsoaledi, has certainly inspired confidence in his acknowledgement of the state of healthcare in the country and his determination to overhaul the system.

To this end, the Department of Health has identified various key priorities embedded in their 10- point plan that systematically seek to address the problems in the healthcare system. Nine of these priorities effectively form the building blocks towards the National Health Insurance (NHI). The last is the revitalisation of the healthcare infrastructure – which involves the urgent refurbishment and preventative maintenance of all health facilities. The revitalisation of the health infrastructure programme will address the question of accessibility, with the vision of most public facilities being brought up to an acceptable quality. The R105-billion allocation for healthcare in the recent national budget is in sync with the Minister’s vision for healthcare in this country. However, the funding of these initiatives will also involve the participation of the private sector.

Health MEC of the Western Cape, Theunis Botha, threw down the gauntlet two weeks ago in a meeting with the private healthcare sector, when he invited from the sector proposals that seek to provide affordable healthcare through private-public partnerships.

It will take a while before these good intentions and efforts are realised by the public. The turnaround is likely to be slow, while the legacy of the current healthcare system will continue to wreak havoc in both the public and private sectors. Medical scheme managers are still grabbling with the devastating effects of the waning recession on their claims cost. The Council for Medical Schemes is conducting an audit into how schemes are handling and paying for prescribed minimum benefits (PMBs) – a list of medical conditions for which medical schemes are obliged to pay in full. Since the interpretation of PMBs and circumstances under which schemes are obliged to pay in full are vague and open to interpretation, this audit is likely to result in huge unforeseen costs for medical schemes.

Unfortunately, even among all the current commendable developments, there is nothing to suggest that healthcare costs will come down in the next year or two. The picture is likely to remain gloomy for a while yet.

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