Another major healthcare group has called for collaboration between the state and private sector, but, writes MedicalBrief, Health Minister Aaron Motsoaledi is digging in his heels on the NHI, calling a legal challenge to the scheme “devoid of merit”, and “discriminatory”.
Life Healthcare this week joined Netcare in calling for government and private business to add health to the list of areas on which they’re focusing to boost investor confidence – and to shore up, more efficiently, the fast-deteriorating sector.
The government of national unity (GNU) is facing a barrage of court cases against its contentious plan for universal health coverage that could take years to resolve, and, said Netcare CEO Richard Friedland, rather than wait for the government to find a way out of this quagmire, the private sector should step in to help. He believes bringing in health as a fourth focus area could help to quickly resolve some of SA’s most pressing healthcare challenges.
Life Healthcare CEO Peter Wharton-Hood agrees, and has welcomed the idea, reports BusinessLIVE.
“I would … commit resources and time to having those dialogues,” he said. “Let’s get patients in need into facilities that are empty. Co-operation between the public and private sector is the way forward.”
Many private hospitals are under-utilised, while public sector patients often face long waits for services ranging from cancer treatment to elective procedures.
Netcare said earlier this week that occupancy in its acute hospitals averaged 64.3%.
Life Healthcare said average occupancy in its acute hospitals for the year to September 30 stood at 68.7%.
Hospital operator Mediclinic said last week that occupancy in its Southern Africa business stood at 69.9% for the six months to 30 September.
“The capacity in the private sector that is not used should be made available to the state (on commercially viable) terms,” said Wharton-Hood.
The private sector was well placed to provide a range of healthcare services to the state, including those required by cancer patients, he added.
It could also play a far greater role than it now does in training nurses, and that effort could be widened to help train other healthcare professionals too – from physiotherapists to medical specialists.
An editorial in BusinessLIVE backs up the proposal, saying Netcare and Life Healthcare both have extensive experience contracting with the UK’s National Health Service (NHS). Netcare tied up deals with the NHS in the early 2000s to provide ophthalmic and orthopaedic procedures, and contracted again some years later through its stake in the UK hospital business General Healthcare Group, which it has now sold.
The private sector could also help deal with some of the equipment shortages and maintenance failings that plague state institutions.
The national public health system is in a precarious state, with even the relatively well-managed Western Cape provincial Health Department buckling under the latest budget cuts and admitting it can’t employ enough doctors and nurses to meet demand.
Countrywide, posts stand empty as the backlog in cancer treatment grows and waiting lists for elective surgeries lengthen.
When budgets are squeezed, provincial Health Departments also cut back in ways less visible, curtailing access to costly life-saving treatments like biologics, and tightening the eligibility criteria for expensive care such as dialysis and organ transplants.
But the National Department of Health has long viewed the private sector with deep suspicion, fearing that outsourcing services will prove unaffordable and deliver profit to shareholders at the expense of the fiscus.
It is missing the point, adds the BusinessLIVE editorial. Contracting private healthcare providers isn’t necessarily about saving money, but drawing on their expertise to do things more efficiently or provide specialised care.
Collaborating with the private sector is no panacea, but it does offer scope to relieve some of the most pressing problems confronting the public health system in the short term.
Blind spot
But Motsoaledi, does not appear to be ready to budge. In his response to the a legal challenge against the NHI by Solidarity, the Minister called the trade union’s case “devoid of merit”, reflecting its “discriminatory and elitist ethos”.
“What appears to be the nub of Solidarity’s complaint is its discomfort with the fact that the majority of the population …now using the public healthcare system …will be afforded access to private healthcare providers and facilities under the NHI Act, which are now the exclusive domain of those who are better off,” Motsoaledi said in court papers.
Solidarity was the first organisation to attempt to overturn the Act after it was signed into law.
The Board of Healthcare Funders, representing medical schemes and administrators, and the SA Private Practitioners Forum, representing healthcare professionals, followed suit soon after.
Solidarity wants the High Court to declare the Act unconstitutional and invalid, setting in motion what is likely to be a long legal battle. It has argued that the Act is vague, impractical, unaffordable, and unconstitutional on multiple grounds.
In his responding affidavit, filed last week, the Minister said the Act was designed to tackle inequity between private and public healthcare, which was “much worse than … under apartheid”.
“Our Constitution demands a healthcare system that is equitable and transformed, and which puts human life and dignity at its centre.”
As NHI is to be implemented in stages, medical schemes would operate much as they do today for at least another decade, said the Minister, estimating this to be a period of between 10 and 15 years.
“There will be a period when both the (NHI) fund and medical schemes are permitted to cover similar services before … the Act is declared to be fully implemented. This will be a necessary part of the process to protect healthcare users from being without cover during the process of moving from medical schemes to the fund.”
The Act did not limit healthcare access. “If there is a benefit which a user would like to access that is not covered by the NHI fund, the user is at liberty to pay for it out of pocket or access complementary medical scheme coverage,” he said. “This is similar to the scenario which plays out now with medical aids and has been implemented for many years without challenge.”
Meanwhile, Rise Mzansi leader Songezo Zibi says the party has reservations about the NHI, and that while it supported universal health coverage that was accessible, affordable and that offered a service which was dignified and of high quality, “we don’t think the NHI will deliver this”.
“The public healthcare system as it stands simply cannot take on the NHI, nor can the fiscus afford it. We must ensure that we build a working system on the current foundation rather than attempt to build something new and expensive.”
Various issues needed to be tackled to build a quality and accessible healthcare system, he told News24, including underfunding and resourcing; corruption; loss of skills to the private sector, other countries and sectors; management and leadership of facilities, and working conditions.
“South Africa needs all of its health facilities to be well-equipped, have sufficient professional and auxiliary staff, and be properly managed and led,” he said.
BusinessDay PressReader article – Minister damns ‘elitist’ challenge to NHI (Open access)
See more from MedicalBrief archives:
Netcare calls for more public-private partnerships
Busa and Health Department have 'constructive' meeting on NHI
Three possible future scenarios for NHI