Underfunded and understaffed

Author: Myra Knoesen

Source: FA News

In South Africa private and public health systems exist side by side. The public system serves the vast majority of the population, but is underfunded and understaffed. The wealthiest of the population use the private system and are better served than the poor.

In outlining the country’s path to universal health coverage, with dramatic changes in the role of private medical schemes, the White Paper on National Health Insurance (NHI) proposes sweeping reforms to the healthcare sector in an attempt to narrow the gap.

The theme for the 2017 Annual Board of Healthcare Funders (BHF) Southern African Conference was centred on how the private sector can embrace the move towards universal healthcare.

The conference boasted a variety of speakers who touched on important points, notably the long road to universal healthcare in South Africa and why it must happen and how our nation will benefit. FAnews spoke to some speakers about pressing issues.

A sustainable healthcare system

According to Chapter 8, sections 305-309 of the NHI Policy document, Dr Sipho Kabane, Acting CE & Registrar of the Council for medical schemes says, it states that membership to the NHI will be mandatory. There will be consolidation of the currently fragmented risk pools and members will be able to make a decision whether they will belong to a scheme in addition to the NHI. There will be tax reforms that will affect the current tax subsidies and credits and medical schemes will provide complementary cover when the NHI has been fully implemented. Medical schemes will cover what is not covered by the NHI.

Dr Ali Hamdulay, Chief Executive Officer at Metropolitan Health, says NHI represents an opportunity for healthcare leaders to assist in building better healthcare system for communities and the next generation. “The objective is to implement a successful and sustainable healthcare system for our people.”

Increasing access whilst lowering costs

According to Hamdulay, it is about increasing access whilst lowering costs to improve health outcomes and user experiences.

The key cost drivers according to Kabane, for private healthcare costs, are service provider tariffs and utilisation. “This includes fraud and waste, supplier and consumer induced demand, cost of technology, exchange rates on equipment and medicines. A better management of all these factors will result in a more effective control of private health costs,” said Kabane.

“The elimination of fragmented risk pools will improve cross subsidisation and will also contribute to the cost-effectiveness and affordability of schemes,” he continued.

The value proposition

When looking at what the value proposition of the private sector for the NHI is Hamdulay says, “The value propositions in the private sector are thought leadership, subject matter experts and optimal operating models. There is an ability to effectively and efficiently solve healthcare related challenges and problems collaboratively.”

“The industry has mastered quick turnaround times in identifying, mitigating and learning from critical challenges. Collaborative relationships of the private sector create greater alignment and trust in the healthcare system,” continued Hamdulay.

So what does the value proposition of the private sector mean for NHI? Hamdulay says it means expedite implementation and reaching end state sooner, learnings obtained to avoid pitfalls of the past, advanced scalable system capabilities that can deal with complex processes, identifying and resolving complex healthcare related problems and challenges, innovative thinking and fresh ideas, governance, knowledge and expertise. 

“The successful implementation of the NHI, based on a social solidarity and access to healthcare for all, is dependent on a collaborative relationship between the private and public health sector. The white paper is a welcoming fundamental step and a clear sign that the private sector will form part of the future of NHI,” concluded Hamdulay.