Uncertain. That is what the future of the South African healthcare system looks like following the release of the Health Market Inquiry (HMI) report as well as the National Health Insurance (NHI) Bill, which is under consideration.
“We are moving into very uncertain terrain because we do not know what the details are going to involve when it comes to integrating the private and the public sector,” said independent health economist Haroon Wadee.
Wadee said this at the Gordon Institute of Business (GIBS), during a panel discussion on the future of the public and private healthcare system in South Africa.
Pricing and access to quality healthcare dominated the discussion.
“We can’t talk access when the pricing of services is out of range. Even when access is there, it is available in minimal terms, and that speaks to quality,” said Dr Ntuthuko Bhengu, HMI panellist and health sector specialist.
Section 27 Executive Director Umunyana Rugege said that the fact that doctors can’t negotiate pricing is one of the reasons that pricing will be a challenge in the future.
“I think it is time now that we think of how parties could get into a room and share information and begin to set prices,” she said.
Dis-empowered and incomplete regulation
Rugege also raised concerns on how patients and healthcare users are disempowered. She said they lack information and understanding and currently there is nowhere to go for them to acquire the relevant information and understanding.
“One of the key things that we understood was that there was incomplete and inadequate regulation in the sector.
Rugege recommends a concentrated effort that investigates the private healthcare system.
“Even though it was never our call to regulate the sector, we believe that even in a private sector and market, the state had primary obligations in terms of Section 27 of our Constitution, to enable and to enhance the right to the healthcare system.”
She says the other fundamental issue is to address transformation and inequality – even in a profits-driven market such as private healthcare.
In Section 27’s view the current health system reflects the inequality in the country.
“We have a private healthcare system that serves a very small percentage of 17% to 18% of the population, yet there are not enough resources in the public sector.”
Dr Eric Buch, a professor at the University of Pretoria’s School of Health Systems and Public Health, says that based on the HMI it would be in the best interest of the private healthcare system to move rapidly to implement the recommendations.
“I say this because the HMI could become irrelevant if the NHI is implemented in the current visage,” he says, as pricing details are still unclear.
“Though there is currently uncertainty on the pricing model, the HMI report helps to lay the foundation in understanding pricing and the reimbursement models. There is a need to be reflective from the public sector side as well as from the private sector side,” says Buch.