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Changes to the current health system, in which some 8m of South Africa's 48m inhabitants have private medical care, into one in which everyone makes use of the same system, are unavoidable.
Discovery and Metropolitan, both major players in the healthcare industry, over the past week declared themselves in favour of a review of South Africa's healthcare system.
Although talks on the National Health Insurance (NHI) system are just starting, they will probably develop into fierce debate. But what these two healthcare providers have in common is the view that the current system of healthcare delivery is unsustainable.
Discovery chief executive Adrian Gore says the skewed division of resources in healthcare cannot continue.
He says 40% of all resources currently belong to the private sector and this needs to be properly redistributed so everyone in the country can enjoy the benefits of appropriate healthcare.
"The private sector is currently spending $1 000 a year per person on healthcare."
Gore says South Africa can certainly not afford the systems that Britain and the US follow. "In Britain the annual cost of the National Health System equals half of South Africa's gross domestic product, and in the US more than SA's per capita gross domestic product is spent on healthcare. South Africa will have to design its own unique system and this will have to be done properly from the outset."
Wilhelm van Zyl, the chief executive of Metropolitan, says it is important to give everyone in South Africa access to healthcare. There is still great uncertainty because no formal policy has been sketched out yet, but he agrees with Gore that a unique South African solution is required.
Gore and Van Zyl's views are endorsed by Louis Botha, an independent healthcare consultant. Botha says it is important for all parties concerned to be realistic about which plans will be viable, given South Africa's current and expected economic and socio-economic situation.
"South Africa differs from countries like Germany, the Netherlands, England, Ireland and Australia, which already have NHI plans. The latter countries have mainly homogeneous populations with very low unemployment rates, good economic growth, higher per capita income per household, and therefore a big taxpayer base. The gap between rich and poor is smaller in these countries, which have a large, stable middle class."
Botha says as a developing economy South Africa cannot yet match these countries' economic indicators, and cannot necessarily therefore afford the same solutions.
"More can perhaps be learned from countries like Mexico, Brazil and India, which have a large number of inhabitants compared with a relatively small economy and a small number of taxpayers.
"South Africa's challenge is problematic because it is actually like a small piece of the first world within a third-world environment. There is little chance of a single solution suiting everybody in such a system."
According to Botha, the NHI's capacity for delivery is another issue needing attention. Aspects like funding, physical delivery of healthcare services by hospitals, clinics, specialists and general practitioner practices, pharmacies, all other medical services and administration, as well as legislation and supervision, have to be in place.
"There must be sufficient well-trained people who are appropriately paid and managed. They will have to deliver an effective public service that is regarded as value for the taxpayers' money.
"The co-operation between public and private players must also be beyond reproach."
Botha hopes that discussions between the private sector and government will be effective. "It would be best if the implementation of any significant changes to the existing system does not take place before all interest groups regard it as an attainable and viable alternative. All aspects must be in place before it is introduced."
Van Zyl reckons all players in the private health sector can contribute to the debate and help find a workable solution. "But intense and complex debate is nevertheless called for before South Africa is on the road to a national health system."
Documentation on the NHI plan, according to deputy minister of health Dr Molefi Sefularo, is not yet available for public debate.
Sefularo and Dr Olive Shisana of the ANC's NHI task team made it clear at the recent Board of Healthcare Funders Conference that the introduction of the NHI could be implemented sooner rather than later.
- Sake24.com
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