Private health sector targeted
S OUTH Africa could not afford to shy away from the uncomfortable truth that poor regulatory control of private health care and weak financing was punishing the poor, Health Minister Aaron Motsoaledi told a meeting of private hospitals yesterday.
Speaking at the opening of the annual Hospital Association of SA conference in Cape Town, Motsoaledi outlined his determination to regulate private health-care costs as one of the many steps needed to achieve universal health-care coverage, or a national health insurance system as it has become known.
Motsoaledi said that many developed countries were “troubled” by similar issues, including the US, where the “Obamacare” health plan could determine the outcome of the presidential elections.
“I am profoundly aware of the fact that regulation is a swear word and seen as interference by the state, but we cannot continue on this risky path,” he said.
“It is a risk that could mature into a crisis in which the state will be accused of poor stewardship.
“We want to work with you under the stewardship of the state. We must talk about regulation, but this does not mean we are against markets, but rather actively for health.”
Commenting on the theme of the conference, “Policy, Practice, Progress”, the minister said the association would not do it justice if it did not come up with a clear stand on the issue of regulation and health financing.
On the challenge of scarce human resources, Motsoaledi said: “If we don’t come together to solve the issue of human capital, we will both perish. I trust we are reading from the same page to find solutions.”
The minister said he was growing accustomed to being accused of “always attacking private health care when I speak”.
Collective
However, he said that universal health-care coverage should not be seen “as a beauty contest” between the private and public sectors.
“It is about how we work together, and I want to add that I have major concerns about the quality of care in the public sector.”
He pointed out that there were problems that required attention, but said that the government had conceded in 2009 that its HIV programme had gone wrong.
“We put up a massive turnaround strategy, but we had to first openly accept we had a problem,” he said.
He added that the issue of the pricing of health care was a “big concern”.
“I do not know of any health minister in the world that is not worried about the cost of health care,” he said.
Health economist Ravindra Rannan-Eliya said that although it would be tough for SA, many Asian countries which had universal healthcare coverage had achieved it while at a similar stage of development.
He said that achieving universal health-care coverage was about solidarity, equity and the need for collective action and collective use of services, but that it was a decision each country had to make for itself.
He said the cost of health care in SA was high and that the country had a serious problem of cost control in the medical scheme market.
“You have some of the highest levels of private insurance spending in the world,” said Rannan-Eliya, who is the director of the Institute for Health Policy in Colombo, Sri Lanka.
He said none of the classical routes to universal health-care coverage fitted SA, and that health-care providers would need large financial incentives to join the proposed national health insurance system.
He added that SA would not achieve a national health insurance system in the next five to 10 years, and that there had to be some degree of state intervention to control the private health-care market, coupled with an improved public sector.