It seems that the underlying assumption of the National Health Insurance (NHI) Bill, which seeks to force the public and private health systems into a hasty marriage, is that throwing money at the current Health Department Crisis will resolve all problems.
In actual fact, nothing could be further from the truth, and in retrospect, the NHI could cause even MORE problems as Key Medical Personnel such as doctors, anaesthesiologists, etc. are vulnerable to leave South Africa should the Bill be passed.
One problem is that the NHI Bill centralises too much power in the hands of the health minister and does not clarify how the scheme will be governed. The current problems that the Health Sector is facing is due to a lack of governance which has led to poor management of every aspect of public health – finances, human resources, procurement and maintenance – this one of the biggest weaknesses of the sector.
More money in the system will not remedy this. It will simply provide incompetent and corrupt managers with bigger budgets to burn.
Parliament’s Portfolio Committee on Health summoned provincial health MECs to the House this month. MPs wanted answers after receiving a report from the Office of Health Standards Compliance (OHSC) that only five of the 696 health facilities it had inspected during 2015/16 had reached the required level. Some of the MEC’s admissions about their provinces were scary.
The Free State reports that 400 cancer patients are waiting for radiation treatment. The province has two radiation machines but one is broken, so it is trying to lease another.
Medico-legal claims are off the charts in some provinces, many involving children who have suffered permanent brain damage. Lawyers have jumped onto this as an avenue to riches. David Motau, head of health in the Free State, said his department had uncovered a “scam” whereby its employees were shifting through patients’ files to try to identify neglience cases for lawyers.
But many of these cases are legitimate and payouts are cannibalising health budgets. Mpumalanga reports an “estimated liability” of R7.6-billion, while the Free State is facing claims worth R2-billion. Even tiny Northern Cape faces claims amounting to R1.4-billion.
According to Wits University’s Professor Alex van den Heever, who has been researching health reform for over 20 years:
“The NHI Bill gives too much discretionary power to the health minister for operational issues, and this makes the scheme vulnerable to being captured,” said Van den Heever.
“It is not appropriate to put billions – about R170-billion a year currently – in the hands of one politician,” said Van den Heever, who spent 10 years as an advisor for the Council on Medical Schemes.
“The National Health Insurance (NHI) Bill is obscure about whether people can buy cover outside of the national scheme, and refers to private cover that is complementary,” said Van den Heever.
“But you cannot just remove a right. The NHI is insurance, not a service. Canada tried to prohibit people from having private healthcare and they lost a court challenge. Prohibition serves no public purpose or social benefit.”
According to the South African Society of Anaesthesiologists (SASA), data from their members showed that almost a fifth of the country’s 2826 specialist anaesthesiologists are “vulnerable to move or leave South Africa”.
Since the release of the NHI Bill, SASA is concerned that this might get worse if government fails to work closely with the private sector on NHI negotiations and implementation.
SASA represents 90 percent of all the specialist anaesthesiologists and anaesthetists in the country and should the 482 they say are contemplating leaving the country actually emigrate, our shortage of these professionals will become even more dire.
Gauteng’s spending has been in free-fall for a number of years. Since 2014, Gauteng has been accruing debt of around R2-billion a year. It has finally settled bills below R10-million but has had to reach agreements with 39 large suppliers to pay them back over two years.
This debt is partly because the province’s health budget allocation has not kept up with the growth in demand for services (up by 5% in the past year). But it is also the result of poor management, planning and alleged corruption involving R1.2-billion between 2006 and 2010, when Brian Hlongwa was MEC.
The province also squandered R22.8-million in “fruitless and wasteful expenditure” in the current year, and has accumulated R443-million in wasteful expenditure from previous years.
In contrast, the Western Cape reported R7 000 such expenditure in 2016/17 and zero in the current period.
The North West wasn’t in Parliament. So great are its failures that the national health department assumed control of it in April according to Section 100 of the Constitution – but too late to prevent billions being bled from the coffers by Gupta-linked acolytes in the province.
Government has tried to contract private doctors to work in public health facilities in its NHI pilot districts, but it has only managed to attract 342 doctors. Only a third of GPs who were contracted said they would stay, blaming lack of equipment and poor working conditions, according to research published in the SA Medical Journal in November 2016.
Last week, the South African Society of Anaesthesiologists (SASA) warned that almost a fifth of the country’s 2826 specialist anaesthesiologists are “vulnerable” to leaving South Africa and that the NHI Bill had made them jittery.
The global minimum standard is to have at least five specialist anaesthesiologists per 100,000 people. South Africa has 2.51 per 100,000 overall and 0.9 per 100,000 in the public sector.
All provinces are struggling with emergency medical services. In the Western Cape, there has been a spate of attacks on ambulances. In the Eastern Cape, only 254 ambulances are in working order.
The Free State is short of 274 ambulances but can only buy 15 this financial year. Mpumalanga conceded to a huge shortage of ambulances and staff, resulting in a slow response time for patients.
Many of the MECs failed to mention mental health, despite the Esidimeni scandal in Gauteng, which has resulted in over 150 deaths of mentally ill patients after being transferred from a psychiatric facility to unprepared and unlicensed NGOs to save money. However, Mpumalanga only has 106 beds for mentally ill patients but estimates that it needs at least 1 214.
The bottom line is that unless the government is able to systematically turn around the longstanding failures related to management, its attempt to force a merger between the public and private sector could well drive more doctors and specialists out of the country and further compromise our health.
SOURCE: Health-e News