Beyond 2010

1. Beyond 2010 Healthcare FundingFor SA By Dr Norman Mabasa Chairman: SAMA

2. 6th PAN AFRICAN HEALTH Conference2010

3. Public Expectations • Right to access healthcare services • Affordable but adequate services • Expectations not equal to rights

4. Government Obs and Resps • To provide healthcate services including and not limited to: • Prevetion • Promotion • Curative • Rehabilitative • Increase access

5. NHI Defined The State undertakes to give money to all its citizens which they may use to pay for their healthcare at any existing point of service for defined or covered conditions

6. Unravelling the Definition • The state on NHI only promises to give money • The state does not say NHI will give you points of healthcare service • The state gives you money to pay for services at existing health facilities irrespective of the state in which they are • Such a facility only needs to be working and must have been accredited

7. Unravelling the Definition… • The questions therefore should be about whether the state can give that money and that’s where the debate is • Whether facilities are there or not that has nothing to do with this promise to give money • The assumption is that such facilities exist and that they are in good working condition • The question would be what would happen if everyone had money of their own to access healthcare today?

8. State responsibility • Not limited to providing money • Extends to provision of healthcare in general • The ten-point plan addresses all areas of state responsibility including NHI as defined • The state is aware of other areas of responsibility which must be addressed whether NHI was promised or not • These areas need not be addressed only if NHI were to be implememnted

9. The 10 Point Plan • Provision of Strategic leadership and creation of a social compact for better health outcomes; (1) • Implementation of National Health Insurance(NHI); (2) • Improving the Quality of Health Services; (3) • Overhauling the health care system and improve its management; (4)

10. Continue…. • Improving Human Resources Management, Planning and Development; (5) • Revitalization of infrastructure; (6) • Accelerated implementation of HIV & AIDS and Sexually Transmitted Infections National Strategic Plan 2007-11 and increase focus on TB and other communicable diseases; (7)

11. 10 Point Plan …cont • Mass mobilization for better health for the population; (8) • Review of the Drug Policy; (9) and • Strengthening Research and Development (10) • MAC to present document to Minister • Minister presents to cabinet • Cabinet publishes for comment • We all now get involved

12. Human Resources • Doctors: 31 330 (end of 2004) now 34 500 • Nurses: 184 459 • Pharmacists: 10 218 (in 2005) • Not all clinically active • Some work outside the country • Many in private practice

13. Health Workers Outside SA

14. Public Hospitals per Province (2006)

15. GDP and Health Outcomes of Selected Countries

16. Population 2004 and 2009

17. Population 2004 and 2009

18. Number of Facilities vs Population

19. Ministerial Advisory Committee • MAC currently deliberating vigorously • Existing documents being perused • MAC to present document to Minister • Minister presents to cabinet • Cabinet publishes for comment • We all now get involved

20. MAC Activities - Advisory • Committee comprises members from stakeholders to serve for 5 years appointed in their individual capacity • Monthly meetings • Confidentiality as no concrete proposals or agreements have been reached • No need for multi-stakeholder involvement at this stage • Preparations for debate essential • Constructive criticism paramount

21. What is NHI? • New funding model • New health card for all registered persons • Introduction of new payment system in both public and private healthcare system • Healthcare free at point of service with a single payer system • Relationship with existing funding models part of the debate • Scope of cover currently being worked on

22. Current System • Medical aid covering the employed for private healthcare • State looking after all citizens, employed and unemployed, covered and uncovered, ‘free at the point of service’ • Both systems replete with deficiencies and excesses • Both systems suffer from misallocation of funds and either over-service or under-service

23. Points of Common Course • NHI is and can be a good concept • NHI will be implemented at some stage • NHI works in other countries very well • NHI could assist in repairing current ills • Current models in both private and public can be criticised • Too powerful private system for few • Too weak public sector for majority

24. After Document is published • This requires engagement and more information • Engagement involves all role-players • Role-players are the public, service providers as well as government • More info regarding source of funds and administration thereof • More information regarding the scope and range of services to be covered

25. Issues to addressed include.. • Where will the funds come from and how much is needed? • Will people still be free to have private cover? • What is the range of services to be covered • Does it include primary, secondary and tertiary care services • What are the limitations or exclusions?

26. Information Needed continue …. • How will it work in the public sector where people currently do not necessarily pay? • How will claims be submitted and processed • How will the current medical aid members benefit? • Will they get less benefits than they have at the moment or will the get same or more?

27. Issues to be addressed …cont • Will administration costs be less than the current private sector admin fees? • Will there be new administrators who may need fresh training? • Who do you cover? • How do you delineate districts and sub-districts? • Any scheme mergers?

28. Who are the Service Providers • Hospitals- public and private • State clinics • Pharmacists • General Practitioners • Specialists • Nurses • Traditional Healers have also show greater interest • Allied Health Professionals, optometrists, physios etc • RAF and COIDA

29. Relationships • Buyer – seller relationships not defined so far • How much the system costs will depend on how much each service provider will accept as remuneration • Private sector buy their pharmaceuticals and equipment using their own funds • The natural question will be how these will be compensated for their ‘investment’ or expense

30. Relationships • Definition of ‘accredited facilities may need to be revisited • What does it mean multidisciplinary practices? • How about PPPs? • Will patients have increased or decreased access points? • How will prices be determined for each provider?

31. Legislation effected by NHI • CONSTITUTION OF THE REPUBLIC OF SOUTH AFRICA ACT,108 OF 1996 Pertinent sections provide for the rights of access to health care services, including reproductive health and emergency medical treatment. • NATIONAL HEALTH ACT, 61 OF 2003 Provides for a transformed national health system for the entire Republic

32. Continue… • MEDICAL SCHEMES ACT, 131 OF 1998 Provides for the regulation of the medical schemes industry to ensure consonance with national health objectives. • MENTAL HEALTH CARE ACT, 17 OF 2002 Provides a legal framework for mental health in the Republic and in particular the admission and discharge of mental health patients in mental health institutions with emphasis on human rights for mentally ill patients.

33. Continue… • CHOICE OF TERMINATION OF PREGNANCY ACT, 92 OF 1996 AS AMENDED Provides a legal framework for termination of pregnancies based on choice under certain circumstances. • STERILIZATION ACT, 44 OF 1998 Provides a legal framework for sterilization, also for persons with mental health challenges.

34. Continue… • SA MEDICAL RESEARCH COUNCIL ACT, 58 OF 1991 Provides for the establishment of the SA Medical Research Council and its role in relation to health research. • TOBACCO PRODUCTS CONTROL AMENDMENT ACT, 63 0F 2008  Provides for the control of tobacco products, prohibition of smoking in public places and advertisements of tobacco products as well as sponsoring of events by the tobacco industry.

35. Distribution of Public Health Facilities in South Africa

36. It is clear that more time will have to be spent on engagement than has already been spent on conceptualisation Agreements are more crucial at this stage and as it looks now work has not even begun to be teased on relationships and identification of all role-players More time well-spent will achieve better results than when this system is implemented in haste and result in worse disaster than is currently experienced

37. Admittedly citizens will expect better than they have now and we all therefore have to manage expectations candidly We need to tell whether all will get equal by getting less or whether all will get same by getting better Whilst we are all tired of the inadequacies of the current system, it does not automatically follow that the replacement is better by default

38. It is not about how good the intention is, it is about how well it is executed It is not about how nice the garment looks, it is about how appropriately it fits the body frame It is not about how successful the system is in other countries, it is about how well they planned for it, it may also include how long they took to plan and make it work

39. Time well-spent on this may be just the only remedy we need for its successful implementation If its done in haste we may end up failing a success we should never have faultered Remember ‘Working Together We Can do More’

40. At the End “Let he that has got ears listen and he that has eyes see but he that has both wisen up” Thank You