Sarah Wild, Business Day
Londiwe Buthelezi, Business Report
Harriet McLea, The Times
THE National Health Insurance (NHI) green paper was decisive about what it wanted to achieve, but "less strong on how", according to KPMG chairman of global health Mark Britnell. The green paper has come under scrutiny with concerns that SA's small tax base of about 5-million people will have to foot the bill for the scheme, even though many already contribute to private schemes. Dr Britnell, who was a key player in drafting the UK's national health system policy, was addressing the first day of the Hospital Association of SA's annual conference. He said that what worked would help patients more than ideology and theory. However, he said the green paper did not outline the details of what it wanted to achieve. The estimated cost of implementing NHI is expected to reach R255bn in 2025. According to data from the Department of Health and the South African Medical Association, 8,2 million people belong to private medical aids, contributing R85bn annually. About 42,3-million – 84 percent of the population - rely on public healthcare. The green paper argues that SA's "two-tiered system of healthcare did not and still does not embrace the principles of equity and access". Moreover, it attracts health professionals to the private sector, leaving the public sector under-resourced. Consequently, "the rationale for introducing the NHI is to eliminate the current tiered system". However, Britnell said reforming SA's health system would require all its players. He said that when people talked about change, it meant everyone had to change - public sector, ministers and the private sector. Britnell said private hospitals would have to open their doors to all South Africans if they were to survive the implementation of the NHI. But before they started serving public healthcare patients, they would have to be transparent about their fees in order to negotiate acceptable NHI prices. He said that that private healthcare providers could benefit from expanding their patient base, adding that if all South Africans were to benefit from NHI public and private healthcare providers would have to trust each other. He also warned private hospitals and the state not to allow the cherry-picking of services they were willing to offer under the new system. Britnell said the UK reforms were a good example of how the public and private sectors could work together to improve public healthcare. He said the UK reforms, carried out over 10 years, faced resistance from trade unions and the public and private sectors. But, he said competition could improve outcomes, and in the UK it had reduced mortality rates, improved quality and reduced waiting periods in the public sector and there was no evidence of increased costs.
Another speaker, Heather McLeod, who has been involved in drafting the technical aspects of SA's NHI, said it was possible to include a variety of funding mechanisms. She said universal coverage was a mix of financing: tax-based, social health spend and private. She highlighted a common misconception about what SA's NHI proposes, saying there was a difference between health insurance and healthcare. McLeod said that while only about 16 percent of South Africans had insurance, about 93 percent had access to healthcare. She said that dissatisfaction with the current national health system was dissatisfaction with the quality of the care in the public sector. However, due to the subsidy ranking system in the health system, if people were not covered by insurance, it resulted in "catastrophic expenditure". She said that anyone earning over R6 000 a month must pay in full when using public hospitals and if they had no cover, it was a catastrophic expenditure. Carla Faustino Coelho, an investment officer at the Internal Finance Corporation's advisory service for public-private partnerships, said new partnerships would have to focus on buying services from the private sector and not equipment and facilities.
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