Netcare CEO Dr Richard Friedland on Monday expressed the willingness of the private health care to work with government in making sure the National Health Insurance (NHI) fund was implemented with ease.
Friedland’s comments follow a widespread concern that the NHI was unaffordable and that it would take too long to implement while most South Africans were already struggling to access quality health-care services.
Speaking at the Hospital Association of South Africa (Hasa) Conference in Sandton, he stated that private hospitals wished to work with government to find solutions to the country’s health-care problems.
The Netcare CEO pointed to mandatory medical cover for the formally employed as a potential solution that has been well-researched over two decades and that it was a “workable solution that if implemented it would be quick to roll out and in a very short time provide enhanced health care to all South Africans”.
Friedland pointed out that the ANC’s 1994 Health Plan recommended mandatory cover for the formally employed and the national Department of Health Social Health Insurance Working Group in 1997 recommended that mandatory cover for formal sector employees should be confined to those above the income tax threshold, due to affordability concerns.
“If the government mandates those South Africans who are formally employed together with their families to be covered by some form of health insurance or medical aid. This will enable public health sector resources to be dedicated to the informally employed, unemployed and indigent.
“With a formally employed population of 11.5 million, together with the estimated number of dependants, based on a 2.4 beneficiary ratio, this could result in up to 27.5 million of our population that could potentially over time become covered, leaving the remaining 35.5 (56% of the population) people dependent on public health resources,” Friedland said.
He further said government public health per capita spend could increase over time by 52% without any additional funding of the public sector budget.
“In simple terms, if one considered the entire population in South Africa, government’s responsibility would reduce from the current 85% of the population covered by public health to 56%,” Friedland explained.
The latest per capita public expenditure based on a consolidated health budget of R271 billion works out to R5 054 when considering the population and excluding medical scheme users.
With formal employment coverage, that per capita public expenditure on public health users would increase 52% to R7 659, research shows.
Friedland alluded that the scheme could be taken from the ground up in just three phases.
“Phase one would involve including the formally employed and their dependants who are above the tax threshold.
“This would grow the medical scheme coverage from 9,2 to 15,4 million. The completion of Phase 1 would also expand public per capita spend by 12,9% at present day levels.
“Phase 2 would include those formally employed and dependents who are below the tax threshold. This would push medical scheme coverage to 27,5 million and expand public per capita spend to 52%.”
Phase 3, Friedland explained, “will allow for the expansion of the economy through recovery and an increase in employment”.
He furthermore told the audience that this would have further benefits to South Africa’s health-care system, with research showing that for every one million formal jobs created, the public health system would benefit with a reduction of approximately 2.4 million people, it would no longer have to serve.
Additionally, Friedland said this would also add a 7% increase from Phase 2 on per capita public health spend.
“The health system stands to benefit in more immediate and visceral ways. The reduced load on the public sector will result in a reduced burdens on doctors, nurses and other health-care workers, will reduce overcrowding, shorten queues and free up funding to fix infrastructure, fund unfunded medical posts, and grow our medical skills training capacity – remember, we have a shortage of 27 000 nurses in South Africa, and this is expected to grow to 70 000 by 2030.”
Friedland said this idea was not a new one adding that similar approaches were being adopted elsewhere.
In Africa, 61% of countries have contributory mandatory programmes for civil servants and 50% of them programmes for sector employees, with private sectors standing ready to explore this idea and others that resulted in lessening the load on the shoulders of all South Africans who needed accessible quality healthcare today.
“We stand ready to collaborate on further system strengthening, to more private public partnerships, to addressing public sector elective surgery waiting lists, to joint efforts on human resource training collaboration,” he concluded.
The Star
