Reshaping the medical industry to benefit all

01 August 2016 FAnews

The cost of medical care in South Africa is not cheap. This is a reality we face.

A number of options that assist the public when it comes to facing these costs do exist, but the reality of the situation is that not every person can afford to belong to a hospital plan or a medical scheme. More needs to be done.

Addressing the media regarding the way forward for the National Health Insurance (NHI) programme, the Board of Healthcare Funders (BHF) and Minister of Health, Dr Aaron Motsoaledi, said that misconceptions regarding the NHI needed to be addressed.

Ignore scare tactics

BHF MD Dr Humphrey Zokufa pointed out that there is a lot of criticism surrounding the NHI, most of which is unfair.

A major rumour that is circulating is that government is implementing the NHI as a means to destroy the private healthcare sector.

“This is not the case. There are no plans, secret or otherwise, to destroy private healthcare. It comes down to this simple dichotomy: South Africa has some of the best private healthcare in the world with some of the best resources available, but these resources are not available to the public,” said Dr Motsoaledi.

Teetering on the edge

The next criticism the Minister addressed is the rumour that the NHI will come at a significant cost. While he did not dispel this rumour, he was quick to point out there are costs currently inherent in the system.

“We are often told that we are attacking the middle class through the implementation of the NHI, but the middle class is being squeezed now. How can we logically explain this situation: twins are born prematurely at a private healthcare facility, they do not receive any extra care at the hospital outside of those provided to normal healthy babies; yet they accumulate a bill of R750 000 over a ten day period,” said Motsoaledi.

He adds that medical schemes have rules, one of which is that they would not pay more than R1 million for the above scenario. Patients blame medical schemes when they should be asking how the hospital came up with their original figure in the first place.

Is there a workable solution?

But do we have a suitable alternative? Dr Zokufa believes that a system like the NHI cannot be ignored and must be implemented as a matter of urgency.

“A key element in the NHI will be the pooling of funds which will give government a significant bargaining chip when it comes to rolling out quality medical care for all citizens. We have seen examples of this in the past. In 2002, government was on the brink of rolling out Anti-Retroviral treatment in rural communities. At the time, it was expected that one patient receiving this treatment for one year would cost government R10 000; yet the effective pooling of funding has made it possible to decrease this cost to R1 000 per patient per year,” said Dr Motsoaledi.

While the pooling of funds is very idealistic, and completely achievable, without addressing the issue of healthcare pricing – and the seemingly free reign that healthcare providers now practice – we are placing a bucket below the leak of a barrel hoping that it will be a solution to the overall problem. Government did not give any indication as to when an effective price tariff model will be reintroduced.

A completely changed system

The final criticism that was dealt with in the briefing was the fact that the NHI White Paper was very vague.

“The BHF is actually encouraged by this. It means that it is unrestrictive and can take into account all of the public comments. This was a deliberate tactic by government who wants to completely change the outlook of both the public and private healthcare system,” said Dr Zokufa.

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