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FINANCIAL MAIL Industry calls for policy changes that will allow public and private sector to work together to ease access The private health-care sector faces significant change with the long-awaited National Health Insurance Bill under consideration by cabinet, and the Medical Schemes Amendment Bill – the latter of which has been delayed until the final Health Market Inquiry report by the Competition Commission has been published. The two bills are intended to move SA towards universal health coverage and reform the private health-care funder and supplier markets. At the heart of SA's health-care system and serving the majority of the population, is a public sector struggling to function despite receiving the second highest allocation in the national budget, with corruption eroding health spending, as has exorbitant provisions for malpractice. The private health-care system, on the other hand, caters for a fifth of SA's population, mainly through medical aid schemes with close to 9 million people (or 15.9% of the total population), members of either an open or restricted medical scheme. According to annual reports from the Council for Medical Schemes, membership is stagnating, which has led to questions about their long term viability. The private hospital sector consists of about 454 private hospitals and clinics with a total of about 40,682 beds, according to the most recent research conducted on behalf of the Hospital Association of SA (Hasa), which represents the private hospital sector. Within the sector, three listed groups – Netcare, Life Healthcare Group and Mediclinic International – are now roughly individually as large as the National Hospital Network, a collection of independent medical institutions. Hasa's research indicates that about R180bn is spent on private health-care in SA each year, of which a third is spent on private hospitals with the three largest private hospital groups contributing R55.5bn a year to the economy, equivalent to 1.3% of GDP. Private health facilities and practitioners are primarily concentrated in urban areas, with more than 40% of private hospitals and clinics located in Gauteng, while the Western Cape and KwaZulu-Natal account for 19% and 13% respectively, owing to the concentration in these areas of medical scheme membership which drives demand for services. The research found that an increase in the number of private hospital beds has coincided with a fall in public sector beds, with the result that over the past 20 years, the overall number of beds in both the public and private sector has risen only slightly, while the population in the same period has doubled. Hasa says this explains the increased utilisation of private hospitals in SA. Encouraging a higher than necessary rate of hospital admissions is poor benefit design for primary health care, which contributes to higher hospital centric care and increased costs, says Angelique Coetzee, chair of the SA Medical Association (Sama). The state of the public sector and anti-selection, among other reasons, also drives private hospital admissions, says Hasa CEO Dumisani Bomela. "We need to urgently make the entire health care system more efficient by finding ways to eradicate duplication, aligning policies to health care delivery and creating closer collaboration between the public and private sectors with the latter, for example, playing a role in the provision of medical skills training and allowing hospitals to employ doctors." Closer collaboration between the public and private sectors should be taking place at many levels, he says, including co-creating legislative and regulatory regimes, allowing private sector hospitals to offer capacity to the public sector in order to help reduce waiting lists. Hasa says policy uncertainty is the most pressing problem. "Policy needs to align and be unambiguous," says Bomela. Sama has previously noted a shortage of both doctors and nurses. This shortage exists in both the public and private sectors, says Coetzee. "The biggest challenge in the private sector is the distribution of health personnel, with rural and underdeveloped areas neglected." She says SA is losing medical specialists as well as family practitioners and scarce allied health professionals to emigration. This shortage is worsened by the fact that SA is not training enough good, quality health care professionals. "Adequate, quality training must be the primary objective."
Created at 2019/03/25 02:37 PM by Mediclinic
Last modified at 2019/03/25 02:37 PM by Mediclinic