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July 2019 Newsletter

NHI: Qualicare calls for calm……Universal Health Coverage is the true goal

In this edition of Qualicare news we offer our overarching vision on Universal Health Coverage for RSA, as well as a summary of the NHI Bill and a booklet explaining NHI, released by the Department of Health for future reference.

Universal Health Coverage (UHC) is not automatically NHI. NHI is the funding mechanism to pay for Universal Health Coverage. The latter is catered for in the SA Constitution as part of the progressive realization of healthcare.

UHC is not a big bang approach!!!

CPC/Qualicare supports Universal Health Coverage for all South Africans regardless of their political, social or cultural affiliation.

This idea of Universal Health Coverage must include patients in both the public and private health care delivery systems.

There is currently a fractured healthcare delivery system in both the private and public sectors.

The public sector has problems including certain units with inept middle management, deployment of persons not always fully qualified for management positions, stock outages, poor staff morale, salary delays, patient overload, lack of basic maintenance, and shrinkage of equipment.

It however remains the State’s responsibility to provide good quality health coverage to all South Africans within a framework of progressive realisation of this goal.

The private sector, on the other hand, has evolved to its current level partly because of the State’s inability to upgrade public health institutions and to meet the healthcare needs of the general South African public, thereby driving many people into private health care.

The private health care system however is also fractured, but this time by the open ended fee for service system, the avarice of certain providers, very poorly drafted regulations of the MSA, misguided removal of tariff ceilings, and the high handed methodologies of certain organisations acting mainly for profit.

To refer to the often mentioned figures that the private sector consumes approximately 70% of the health care budget to look after 9 million people, as against the public sector only obtaining 30% of the healthcare budget to care for 41 million people, is an aberration of the facts.

The healthcare “budget” is not directly influenced by the private sectors spend, as there is no private healthcare budget per se. If we want to be correct, we should talk of the health care spend for RSA, not the healthcare budget.

The Private sector is indeed responsible for a disproportionately large % of the healthcare spend however the private healthcare system is funded primarily through payment of subscriptions to medical aids with after tax money, as well as by salary sacrifices for membership to private or state run medical aid. There is also a small tax rebate on subscriptions and on medical expenses rejected for payment by the medical aids.

The public sector, on the other hand, is funded from general taxation and this sector does have a budget which is set by the relevant department. It is however not directly impacted by the spend of the private sector, except where patients’ funds run dry, or where the State is the DSP for PMBs.

Government frequently emphasises that the public sector has no access to good quality healthcare as it cannot afford private care. This is true in many instances as the public sector health care offering is often dysfunctional, inefficient, poorly run, and therefore not the first choice of many SA citizens who prefer to pay for a medical aid or out of pocket, for good quality health care. This applies to both rich and poor. It is not the fault of the private sector.

It is trite that the duty of the SA Government is to provide good quality healthcare for its citizens via public sector health offerings.

It would therefore be ill advised to attempt to legislate the private sector out of mainstream healthcare (as has been suggested in the draft bill) and confine it merely to complementary health offerings not offered by an NHI funded public sector.

Far better rather to utilise the strength and efficiency of the private sector in PPPs with the state sector to service the public with overflow of patients from an upgraded, better regulated, better staffed and more motivated, better stocked state hospitals and clinics at a mutually agreed rate, (and not one which is imposed upon the profession by health economist academics). Government should strive to make the state sector appealing to the population.

In supporting the concept of Universal Health Coverage, CPC/Qualicare fully supports the right for all citizens to have access to high quality healthcare and to choose a private healthcare plan should they so choose, based upon access ability, affordability and quality.

The current NHI Bill has not yet been finally costed nor tested for affordability. Figures in the billions are bandied about, but are merely guestimates. The pilot projects at general practice level have almost all failed. The majority of state hospitals, day hospitals and clinics will, it is reported, not pass the accreditation requirements of the Office of Health Standards Compliance.

UHC is a process and being part of this journey is the duty of all South Africans. The current bill will doubtless undergo numerous changes before its final passage into law. Thereafter the regulations pertaining to the new act will be written and slowly debated and rewritten and eventually passed, after public hearings and input from the organised profession.

CPC/Qualicare sees it as its duty to be there, make presentations and protect the precious offering which our Private Family Practitioners have made for so many years. 

The infrastructure will take many years to build and install. 2026 Is very close and NHI will almost certainly be nowhere near successful implementation by then.

We will therefore neither make comments offering blanket support for the current bill, nor will we reject it out of hand, but rather offer our wholehearted participation in the process and our willingness to shape legislation to make efforts for Universal Health Care to become a successful goal for our Private sector doctors, the state medical sector, and the patients of SA.

Calm and sanity must be allowed to prevail together with pragmatism and solid inputs from mature well supported doctor based organisations like CPC/Qualicare.

Finally, with our miniscule tax payer base, basic essentials such as electricity, water, food and transport are a prerequisite needed to make any health plan work.

Which of these needs to come first?

Tony Behrman and the Qualicare team

Last modified on Thursday, 25 July 2019


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