The private sector has a vital role to play in implementing National Health Insurance, an adviser to the South African Department of Health told delegates at the annual Hospital Association of SA (Hasa) conference.
"We must have a clear and firm commitment to partnerships with all stakeholders, including the private sector," Vishal Brijlal, a technical adviser on secondment from the Clinton Health Access Initiative is quoted in a Business Day report as saying. Interested parties would not "wake up on 1 April, 2026 and by some miracle expect everything will be in place. This is something we must recognise across society – politically, as well as by stakeholders," Brijlal said, referring to the sensitive issue of how the transition to universal healthcare will be made.
The report says Health Minister Aaron Motsoaledi and his department have drawn fire from Cosatu for signalling a continued role for private healthcare players under NHI that the trade union federation wants to exclude. Cosatu has also taken issue with the Department of Health’s plans to allow medical schemes to have a role in the transition to NHI: it wants a single fund that pays for all the services under NHI and is opposed to alternative financing mechanisms.
The private healthcare industry plays a strong role in the economy, with the three biggest private hospital groups contributing more than R5.5bn, or 1.3% of GDP in 2016, according to research presented to delegates by Hasa chair Melanie da Costa. For every R100 of private hospital services delivered, South Africa's GDP grew R123, da Costa said, citing preliminary findings from a study Hasa had commissioned from the consultancy Econex.
The report says the study is based on data from the country’s three JSE-listed private hospital groups – Netcare, Mediclinic International and Life Healthcare – and excluded the effect of independent private hospitals and those belonging to the National Hospital Network.
The report says Netcare and Mediclinic International welcomed the pragmatic approach flagged by Brijlal, with the CEOs of both companies saying private hospitals could reduce waiting times in public hospitals, play a greater role in training healthcare professionals, and help tackle extensive health issues the state had identified among pupils.
Discovery Health CEO Jonathan Broomberg said the lack of trust between the government and the private sector was hobbling progress. "One of the critical priorities is for the leadership of [the] government and the private sector to try and find that trust again and identify … quick wins.
"The beneficiaries would be the patients who are deprived of healthcare. The ruling party would benefit through visible service delivery, and the private sector would benefit from enhanced credibility," he said.
Koert Pretorius, CEO of Mediclinic Southern Africa said the private sector could offer its spare capacity to the public sector and could offer to treat a percentage of prioritised cases at a lower cost, and it could focus its attention on rural areas, in schools, and support or manage some primary healthcare clinics. Pretorius also introduced research conducted amongst a sample of people earning R6,400 to R16,000 (approximately representative of a national population of about 7m) that shows that this group, who has a high incidence of non-communicable diseases, are willing to pay up to R350 per month for primary care. This group could be covered for 45-50 conditions at this payment, which could represent 85% of basic healthcare needs.
Dr Richard Friedland, Netcare Group CEO said that all efforts to build a sustainable society would stumble without a strong and sustainable health care system – and that the South African system is “incredibly” unequal, but that the widespread knowledge gained from local private hospitals international operations are invaluable to South African health care reform. As an example, he cited the case study of Netcare’s UK group reducing cataract treatments from more than a day to mere hours, using mobile clinics and doctors with deep experience in this procedure.
Broomberg noted that the basic principal of universal healthcare is access to health care of decent quality, and that this right was being denied to many South Africans. “There are literally hundreds of variations of universal health care, and each system has to evolve to address current realities in the country the system is being implemented. The danger is we continue to have theoretical debates and do not do what we need. We are out of time and cannot afford to lose this opportunity,” said Broomberg.
[link url="https://www.businesslive.co.za/bd/national/health/2017-09-27-private-sector-is-vital-in-national-health-insurance-transition-says-adviser/"]Business Day report[/link]