Call for state health scheme

The conservative Medical Association of South Africa (Masa) has advocated a radical reshaping of the way health care is provided and paid for in South Africa.  This week it proposed that a state health plan under the control of a single ministry of health should assume responsibility for providing a basic set of medical services for all South Africans, "in the shortest possible time". Its new approach stands in contrast to a policy that in past years concentrated mainly on defending doctors' incomes against what it regarded as insufficient payment by medical aid schemes.

As the medical schemes come under pressure and the political democratisation process gathers momentum, it has come to be accepted that the way health care is provided in South Africa has to change. Against that background Masa this week released a wide-ranging working document to be used to develop health policy. In advocating a form of national health Scheme, it rejects the notion that the market alone can provide medical treatment for all South Africans. "It's a recognition that Masa's always stated goal of providing good health care can only be achieved with extensive state intervention and state financing,” notes a health policy researcher.

The key concept in the document is "core health" services, such as treatment for illnesses. Everyone should have reasonable, affordable access to these, and the state must help pay for those who can 't provide for themselves. Masa proposes that such core services be defined by the government in consultation with informed community representatives. How much the individual would pay, if anything, would depend on how much he or she earned. Masa suggests a "means test". It would not depend on whether the individual had "top up" medical insurance or a medical aid scheme for services which are not "core".

On the other hand, supplementary medical insurance would not be tax-deductible. Masa proposes a "national health care financing system" funded from general tax revenue as opposed to funding from a special tax on employees, such as the special social insurance taxes common in European countries. Masa acknowledges the current funding system, which it describes as a "voluntary system with a state-provided safety net", is insufficient.

Now the health system promotes multiple standards of service, where income, insurability and geographic location all determine the quality and range of access to health services, according to Masa. The state health plan will have important con­ sequences for the players who now dominate the health scene. For instance, the document poses the question whether medical aid cover for core services will actually be, necessary if the state does extend its health involvement.

Masa also suggests the role of the state in financing non-core services should be reviewed.  Masa admits using general tax as a source o funds for this purpose has the weakness of not pro­viding incentives for cost-effective use of medical services but it believes this is the best route. There is no clear definition of the scope of the government 's responsibility in providing health services. It proposes that state spending on core health services be budgeted for, and reported on, separately from other health services.              

This article originally appeared in the Weekly Mail.

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