Access to cheaper drugs is one of the main benefits for patients in the new health care plan about to be announced by the Ministry of Health, writes Pat Sidley
AFTER months of haggling, the medical gurus have finally come up with a new primary health care plan for the country.
Although Minister of Health Dr Nkosazana Dlamini Zuma will only reveal details next month, the Mail & Guardian can disclose that the health package is likely to include:
* Access for both state and private managed care patients to cheaper “essential” drugs.
* An organised referral system with the division of the country into district health authorities, with local clinics to deal with primary health care needs as well as accredited private practioners including GPs, nurses and pharmacists.
* The private sector will remain intact for those wishing — and able — to use it. But there will be increased co-operation between private practioners and the state sector at district health level.
A major casualty of the process is likely to be some of the financial interests of the multi-national pharmaceutical groups, who are gearing up to face the challenges ahead.
The drug industry faces two-pronged action with separate legislation governing the pharmaceutical industry in addition to measures provided in the national health plan intended to drastically reduce drug costs — a major part of escalating health care
Predictably the resistance to the proposed national health plan is coming from these interests as well as from dispensing doctors who have long been used as the marketing arm of the drug companies.
According to industry sources, the committee looking into financing a primary health care plan found that the funding gap between what is available for primary health care and what is needed is much smaller than
It’s funding proposals include:
* Some form of payroll tax — but set at a low of 0,56 percent of the employee’s income and not at the 3 percent envisaged earlier.
* A levy on managed health care schemes such as medical aids, insurance companies or health maintenance organisations. This may include the removal of an implicit state subsidy to the industry in the way it is taxed at present.
Industry sources say the levy is most likely.
Several meetings have taken place between Zuma and colleagues Chris Liebenberg and Alec Erwin in the finance ministry to examine the merits of various
One of the major improvements consumers are likely to encounter will be in the form of a primary health care drug package (PHCDP) which will become available to both state patients and those in the private sector using medical aids, insurance or similar managed care
The state is likely to set what are known as “essential drug lists” at several different levels.
These have been worked out as being the most cost effective drugs which treat the most common diseases encountered most effectively.
Research for the committee has shown, for instance, that for most primary health care diseases (colds, sore throats and so on) a drug package need only cost R5,60 calculated at the state tender prices and using largely generic (non-brand name) drugs. According to drug industry sources, this will be even cheaper (R2,20) if it is calculated at the tender prices used internationally for the World Health Organisation. This essential drug list (for the PHCDP) will have around 150 drugs on it to choose from.
Private health care consumers will acquire their drugs, which will be prescribed from this list, through community pharmacies which will charge only a professional fee per prescription (said to be around R8,50) — and not a percentage of the cost of the drug plus a large mark-up.
The latter method of charging for drugs, which is the way they are charged for at present, is widely held accountable as a major reason for the enormous cost of drugs to consumers.
District health authorities, into which the country will be divided, will have a list of around 400 drugs to choose from. Individual clinics will have immediate acces to about 50 different drugs. Tertiary health care institutions — such as the large teaching hospitals — will have a list of between 450 and 550 drugs.
Private health care interests — doctors, specialists, and private hospitals — could continue to prescribe or stock what they want to — but the increased competition in the field will force them to look more carefully at cost containment.
Measures in the new plan aimed at making state doctors happier, and drawing private doctors into the state system are likely to be introduced.
Public sector doctors are likely to find their salaries increased and private doctors will be encouraged to do “sessions” at state facilities with improved remuneration for these.
Some system of referring from nurses at state clinics to private doctors at a fee is likely to be introduced.