POLITICS

How to fix public healthcare – DA

Statement issued by Democratic Alliance June 9 2008.

DA presents alternative to the National Health Amendment Bill

South Africa has, on the one hand, a superb but expensive health care service in the private sector, and on the other hand a decaying health service in the public sector. This is a problem that needs to be resolved. As with education, however, the State has chosen to tackle this problem by destroying what works rather than focusing on what doesn't.

The Minister of Health last week tabled the National Health Amendment Bill, a piece of legislation which will effectively give her the power to determine private sector hospital fees. Rather than looking for ways in which to make the skills and high quality of service in the private sector more accessible to more South Africans, the Minister has taken a path that will very likely cause South Africa to lose these skills completely.

There is no doubt that prices are too high in the private sector. But this is the government's fault for creating an uncompetitive and over-regulated environment, and for enforcing an artificial divide between the public and the private sectors.

The Democratic Alliance's (DA) plan, which we present today, is aimed at bridging this divide. We believe that the potential exists for our country to deliver a world-class health service that meets the needs of all its people. This cannot be done through the Health Amendment Bill, but rather by harnessing the skills, resources and enormous medical talent in the private sector for the benefit of all. In the document we present today we make our own proposals to attain this vision.

Current health policy is aimed at creating a strict separation between the public and private sectors and tight, centralised control over public hospitals. This has created many of the problems with competitiveness and quality that plague the public service, while also ensuring that prices remain high in the private sector because of a small and captive market.

The DA believes that the state must continue to subsidise health care for the poor and supervise its delivery. But a radically different management model is needed.

The DA's plan will allow each public hospital currently administered by the State to be run as an independent management unit. Each hospital will receive a block subsidy from the Department of Health based partly on the level of care provided and partly on the number of patients treated. Indigent patients will receive the full subsidy allocation, and patients with an income above a certain level will receive no subsidy, with a sliding scale in between.

This would be similar to the system that is currently used to allocate university subsidies, whereby the state gives out a block grant to each university to be used at the discretion of each institution. 

Hospitals will be obliged to accept all patients and they will also be obliged to make a prescribed package of services available to all. They will also be subject to strict standards to ensure that quality is always maintained at an acceptable level.

The management of every public hospital will be put out to tender, and the door would be open to any of South Africa's private health care providers to submit tenders for a contract to run any of these hospitals.

The DA would specifically target for management-transfer those public hospitals that have been most plagued by delivery problems - and Frere Hospital would be top of our list.

This must go hand in hand with better information for patients so they are able to compare benefits and costs of the service they need. In 2005 Discovery Health implemented a star rating system for South African hospitals, aimed at giving patients the ability to choose a hospital that offers quality care and that is also cost-effective. A similar system needs to be developed and applied across the board to all hospitals in both the public and private sector.

We also call for the urgent implementation of the Office of Standards Compliance, which is mandated in terms of the National Health Act, to exercise oversight over both the public and the private sectors, but which has still not been implemented although the legislation was passed four years ago.

The DA's proposals would also require a fairer system for accessing medicines, which comprise a large chunk of health care costs. We believe that the current system, which entrenches low medicine prices in the public sector in exchange for higher prices in the private sector, must change, and medicines should be marked at the same price to all patients. 

At the same time, patients should be able to claim rebates on the cost of these drugs according to the income-based formula that already applies to patients admitted to public hospitals, whereby the poorest patients receive free services.

All patients would then be able to collect their drugs from the nearest convenient location, including ordinary pharmacies. This would mean public patients would no longer have to queue for hours or days at hospitals, and it would also improve the prospects of pharmacies battered by new medicine pricing regulations. 

The DA believes that we need to develop ways to make the most constructive use of the skills we possess in the health care sector, not destroy them. We will be presenting this document to the Minister in the hope that she will reconsider her approach.

This is the text of a joint statement by Democratic Alliance leader Helen Zille and DA spokesperson for health Mike Waters issued June 9 2008