December 2015 SANews; Health Minister Aaron Motsoaledi says the effective implementation of the National Health Insurance (NHI) is key to improving service delivery in the health sector in South Africa.
The Minister briefed media in Pretoria on Friday after Cabinet approved the White Paper on the NHI for South Africa for public consultation. The NHI, a health financing system that is designed to pool funds to provide access to quality, affordable health care, is part of government’s major health sector reforms and is being rolled out over a 14 year period.
The NHI will see South Africans accessing health care, based on their health needs, irrespective of their socio-economic status. The Minister said on Friday, at the release of the White Paper, there was no alternative to redeeming the health sector, other than implementing the NHI.
“A number of initiatives must be introduced to improve the performance of the health care system, the service delivery and management and quality of health care,” said the Minister.
The public sector currently provides health services to the majority of the population and, Minister Motsoaledi said, it will continue to be the backbone of the health care system.
However, he raised concerns regarding both public and private health care, which he believed the NHI will address.
Challenges in the public health care system
One of the challenges in the public sector health care was human resources. “Wrong people are being appointed in wrong places, patronage and cronyism, poor planning, development and management of HR,” said the Minister.
There are problems around financial management which has led to unfavourable audit outcomes except at national level and in three of the nine provinces. Procurement and poor infrastructure are also challenges within the public health care system.
He said the country’s health system experiences a number of structural problems that adversely impact on the health and well-being of the population, including cost drivers in the public health sector.
Minister Motsoaledi said the main cost drivers other than human resources in the public health sector are pharmaceuticals, laboratory services, blood and blood products, equipment, and surgical consumables. “These cost drivers adversely impact on the efficient and effective service provision,” he said.
Challenges in the private health care system
A total of 16.2% of South Africa’s population is privileged to receive better health care services because they are covered by medical aid, while above 80% of the population is limited to accessing public health care services.
Minister Motsoaledi said South Africa spends 8.5% of Gross Domestic Product (GDP) on health and 4.1% of the GDP is spent on 84% of the population, the majority using the public health sector while 4.4% of GDP is spent on only 16% of the population in 2015/16.
Over the years, the costs in the private health sector have increased. Legislation and other tools have not yet gone far enough to regulate the entire private health care sector and consequently medical scheme members are not well protected from the escalating costs of health care.
Benefits covered by medical schemes are usually not comprehensive resulting in members having to make substantial out-of-pocket payments.
The private health sector is characterised by exorbitant costs due to a fee-for-service model, imbalance in tariff negotiations between purchasers and providers, and small and fragmented risk pools in each medical scheme.
The Minister said private hospital real cost trend started increasing in 1998 and it continues to increase. Minister Motsoaledi said all these problems will be addressed if the NHI is implemented effectively.
These challenges required an “innovative disruption”, which include changing policies and the way things are done in the sector.
“We need a massive reorganisation of health care in the country, in both public and private sectors. We are going to disrupt everything that is happening in an innovative way.
“We are going to pick out all the things we need to change in the system, using the white paper,” he said. Implementation of the NHI will provide an opportunity of yielding significant and better-spread economic and social benefits for the South African population.