Find common ground, collaboration for health insurance

IN OUR response to the National Health Insurance (NHI) White Paper that was released in December 2015, the Hospital Association of South Africa (HASA) argued for collaboration and for concurrent actions to the design of the insurance that would address a number of urgent health-care delivery issues, mainly the human resource and infrastructure shortages that are spread throughout the system.

Our argument was that without paying substantial attention to health-care delivery platforms we would not be able to meet the aspirations of universal health care. While our position is unchanged, we are optimistic that we might be on the cusp of beginning to resolve some of the pressing delivery issues we face.

For one, our calls for collaboration were loudly echoed at the the recent Board of Healthcare Funders Conference held in Cape Town, where delegates were told by speakers from the US, Ghana, Croatia and Kenya – all countries where forms of universal health care have been implemented – and by the board’s own acting chief executive, that the chances of successfully implementing universal health care would be significantly improved with collaboration between the private and public sectors. We endorse this view but would add that any such collaboration must be between equal partners. No one party has all the solutions necessary to address the immense health care challenges that South Africa faces.

Secondly, the recently re-released White Paper incorporates the formation of several committees that will be responsible for providing solutions to a number of pressing issues including human resource development. We look forward to putting our ideas forward to this structure, for inclusion in their recommendations leading hopefully to swift actions – after all, the targeted implementation date for the insurance is a mere eight years away and we have tremendous resource shortages that have built up for more than two decades.

For instance, we have a shortage of nurses that is estimated at anywhere between 40 000 and 80 000, and a particularly acute shortage of “highend” or specialist nurses. Since democracy, we have added just one medical school to the existing eight that together produce 1 400 doctors a year so that our production of doctors has stalled, during which period the population has doubled, and the burden of non-communicable diseases has grown ever-heavier.

Added to these human resource challenges, South African hospital bed numbers across the private and public sector are roughly at 1976 levels, according to research provided to the Healthcare Market Inquiry; and of course, our primary health care system that perhaps more than any other single component supports universal health care, needs urgent revitalisation, resourcing and empowerment.

Lastly, now that the NHI has been gazetted, our attention should hopefully naturally come to focus on finding common ground for implementation.

None of this is to dismiss the pressing and ongoing questions regarding the design of the NHI, including its financing and cost, the final benefit design, the future role of medical schemes, constitutionality, systems design and so on – each needs a convincing answer that goes to the heart of what we can and cannot do, and what we should and should not do.

Nevertheless, the time has never been better to collaboratively find solutions. If we miss this opportunity, and cannot resolve the many health-care delivery issues we face and so empower the NHI, we will have achieved little except to raise, and then dash, the expectations of all South Africans. And this, we simply cannot afford to do.

Bomela is chief executive of the Hospital Association of South Africa