Regulation of SA doctors back on the agenda

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The White Paper on National Health Insurance (NHI) is complete, but reports The Mercury, Health Minister Aaron Motsoaledi still needs to present it to the cabinet before making it public. "We have given it to the Treasury (for a financing model) and at the next cabinet space I have, I will present it. In dealing with the issues going forward, what I can say now is that technology, different business models and a change in behaviour in public health facilities will all be central to changing public health care in South Africa," said Motsoaledi, who was speaking at a medical conference at the weekend. The White Paper is set to map out how the NHI will be introduced.

According to the report he told Parliament last month that his ministry had kept within the schedule of 14 years to roll out the NHI and that the first phase, in which at least 10 pilot sites across the country were set up, had been done. He said a lot of work was still being done behind the scenes on the concept of the ‘ideal clinic’ which would have 134 elements – including an efficient human resources team and proper infrastructure.

Motsoaledi was speaking at the Hospital Association of SA represents private hospitals including the JSE-listed hospital groups Netcare, Mediclinic International, and Life Healthcare. Its annual conference gathers some of the most influential players in the private healthcare sector.

“Universal health coverage; that every citizen must have access to good affordable health care services, regardless of their socio-economic conditions.”

Motsoaledi says while some sectors remain sceptical about NHI, he is adamant it’s the only way to provide equitable healthcare to rich and poor.

He adds it does not make economic or political sense not to provide universal health cover to all citizens.

Motsoaledi also said he would, this week, be in New York to attend the UN General Assembly where 17 new goals – three of them in health – would be set out. A technical specialist on health economics for the NHI in the national Department of Health, Dr Aquina Thulare, said its purpose was to ensure affordable and equitable medical care was available to everyone, not just those who could afford it.

"South Africa's health-care system is highly fragmented and unequal; in terms of human resources, the medical profession is highly skewed towards the private sector. More than 60% of the poorest in South Africa have the highest need for health care but derive the least from the health system," Thulare is quoted in the report as saying.

And, Motsoaledi noted, he would make public the findings of a task team headed by Professor Bongani Mayosi – who probed the workings at the Health Professions Council – within two weeks.


The Health Department's controversial plan to use a "certificate of need" to regulate where doctors work was among proposals contained in the White Paper, Motsoaledi said. Business Day reports that the department has for years tried to introduce a policy that directs healthcare resources to where they are most needed, but has repeatedly run into obstacles.

In January, the Constitutional Court agreed to a request by the Presidency that it set aside a proclamation bringing into effect sections 36 to 40 of the National Health Act, which required all health establishments, including doctors' practices and private hospitals, to obtain a certificate of need. "I want to inform you that the only reason it (the law) was withdrawn was because it was very badly written," said the minister. "It is in the White Paper. I don’t understand why people regard it as a monster," he said.

The report says Motsoaledi was silent on private sector prices, on which he usually pulls no punches. But he signalled a strong role for the private sector in NHI, saying the government envisaged "utilising both the public and private healthcare space". He was puzzled by the public's response to the Gauteng Health Department's proposal to treat some public sector patients in private hospitals. And Motsoaledi urged the private healthcare sector to devise new business models to help South Africa "leap-frog" to a new paradigm.

Pretoria University's dean of health sciences, Eric Buch, said the national health pilot project, launched in 2011, had strengthened the public health system in the 11 districts in which it was running, but had yet to experiment with approaches to financing and contracting.

One of the biggest challenges for private healthcare was winning the trust of government, he said in the report. "There are many influential people in the National Health Insurance policy environment who do not feel the private sector can be trusted to deliver affordable health services in private hospitals for the poor."

Full report in The Mercury Full Business Day report

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