Most South Africans have sickened under one of the=20 world’s most skewed and inefficient health care=20 systems. It’s been in desperate need of major surgery,=20 and Health Minister Nkosazana Zuma is to be commended=20 for bringing an extensive, carefully constructed set of=20 proposals to the discussion table a little more than a=20 year after coming to office.
The report tabled this week offers a solid foundation=20 for a more equitable primary health care system. It is=20 an ambitious and impressive attempt to overhaul the=20 system, balancing a pragmatic treatment of the private=20 sector with bold treatment of the public sector, in=20 pursuit of the original aim: equitable access to health=20 for all.
But it now confronts government with a mighty=20 challenge: money and delivery.
Where is government to find the estimated — and some=20 say it’s very conservative — R3,4-billion shortfall=20 over the next five years? The inquiry prefers to leave=20 that to the fundis in the Treasury. This is fairytale=20 stuff. Imagine if every government department devised=20 its best plan and presented it to Cabinet saying: this=20 is what we need — you find the money! Kader Asmal=20 wants clean drinking water for every person in the=20 country, Sankie Nkondo wants a house for every family,=20 Derek Hanekom wants a plot of ground for everyone …=20 The cost? well, that’s the finance minister’s problem.
Surely a more realistic scenario for overhauling this=20 crucial sector would have been for Cabinet first to=20 have given the good doctor-minister an estimate of=20 Health’s claim on the tax base of the country, and then=20 sent her and her team to the drawing board to devise a=20 health care system within the parameters of=20
The minister now faces the prospect of having raised=20 expectations and then not being able to deliver unless=20 the money can somehow be scrounged from Ronnie Kasril’s=20 corvettes or the sale of a foreign embassy or two –=20 or, as some have already expressed fears, of ad hoc=20 cutbacks in health care services or sudden fee hikes as=20 we go along.
Good ideas are good. Affordable ones are better. Good,=20 affordable ones are best.
The plan will bring significantly greater public=20 spending on health –possible moving it from three=20 percent of GDP to four percent. Private spending on=20 health is currently at five percent of GDP. If this=20 moves up, then it will take us to near 10 percent,=20 higher than almost every country except the United=20 States — and we know the problem the Americans have=20 with health spending.
The solution to this is not likely to lie in cutting=20 back on our sickly public health service. It will=20 certainly lie, at least partly, in better utilisation=20 of the current budget to reduce wastage and abuse.
But the private sector will also have to come into=20 focus. The report assumes that market forces will deal=20 with this through increased competition and the play- off between the public and private sectors. Much=20 depends, therefore, on private doctors and medical=20 institutions taking this on board and adjusting to the=20 inevitable changes of the proposed new system.