NHI: The DA's five steps towards achieving quality healthcare for all
The Democratic Alliance (DA) believes that while solutions for healthcare problems need to be openly debated, the presently mooted, cumbersome National Health Insurance (NHI) plan will not reach the required outcome of achieving quality healthcare for all. Around 85% of South Africans rely on the public healthcare system for all their healthcare needs, and as it stands the South African public health system is crumbling.
The rising costs of private healthcare are beyond the means of the vast majority of South Africans. The poor level of public healthcare would be a major problem even in a healthy society, but considering South Africa's heavy burden of TB and HIV/AIDS the problem becomes seriously intensified. It is crucial that a means to deliver quality healthcare for all is identified.
While the DA supports individual aspects of a NHI such as compulsory medical aid contributions, we believe that an expensive, complex and layered system is not the solution to tackling the health care problems facing our country.
The DA will be analysing the proposals made today by Health Minister Aaron Motsoaledi in detail. However, by way of an initial response, the DA believes that there are five key steps that need to be taken to move our country towards achieving quality healthcare for all.
These five key steps are as follows:
1.) Fix the basic problems facing public healthcare
It is not necessary to increase the tax burden, certainly not while structural problems crippling healthcare remain in place. The Finance Technical Task Team of April 2009, who compiled the report of the Minister's Advisory Committee on Health pointed out that, "The failure to achieve substantial health status improvement appears unrelated to South Africa's allocation of public funds which are not low by international standards." The task team identified identified poor management systems and lack of sufficient oversight as key problems facing the public healthcare system.
2.) Prioritise structural changes in the healthcare system
Insufficient funding is not the biggest problem facing public healthcare, rather the greatest problems being faced are a lack of accountability, weak and incompetent hospital management; a cumbersome management structure; a lack of oversight in the public health system and no effective feedback system regarding quality of healthcare being received. These are all structural problems that will not simply disappear as a public healthcare system is extended. Unless these structural problems are corrected, no amount of money or complicated bureaucracy will make the healthcare system any better.
3.) Assess the affordability of NHI
The general consensus among independent economists is that we cannot afford NHI. Estimates say that by 2020 NHI could cost R214 billion, and as much at R255 billion in 2025, while in 2010 the Treasury allocated R105 billion for health. Introducing NHI in the form that has been proposed thus far will increase the tax burden on a very small percentage of employed South Africans, putting pressure on the economy at a time when the economy can ill afford it.
4.) Undertake a comprehensive review of hospital management
In this regard the DA proposes that two steps be taken. First, the quality of healthcare provided by the public sector needs to be monitored more closely. The Office of Standards Compliance has already been proposed by the Department of Health but in a very weak form, under the authority of the Department of Health. For quality management to genuinely be improved, this Office needs real power and independence. Secondly, there needs to be a change in the attitude towards the private sector. The private sector has enormous potential to improve the quality of the public sector, and has offered its services in many different areas in this regard. These offers have largely been ignored.
5.) Improve the human resources capacity of the public service
As it stood in 2010, the weighted average vacancy rate for GPs was 49% in the public sector. The public healthcare system does not have the human resources capacity to function effectively, and the Department of Health does not have a human resources plan in place to fix this problem. Forcing GPs to leave the private sector to work in the public sector, certainly as the public sector currently stands, would result in further flight of health professionals. The DA recommends that the training of new doctors and nurses is prioritised.
This can be achieved ideally through partnerships with academic and training institutions in the private sector; opening more public and private nursing colleges and medical facilities, and redistributing teaching and research funds to lower levels of care so that not all teaching is done at hospitals. In addition, the DA believes that retention of skills in the public sector needs to be prioritised. This can be achieved through the development of creative mechanisms to support trainee medical staff in the workplace through mentoring, apprenticeship, and ongoing support.
Statement issued by Mike Waters MP, DA Shadow Minister of Health, August 11 2011
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