kakoloti - key issues facing the health sector in the next five years (2007)
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8/7/2019 Kakoloti - Key issues facing the health sector in the next five years (2007)
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Key issues facing the health sector
in the next five years
Thabo RakolotiDirector: Public Private Partnership
National Department of Health
The BHF Annual Southern African Conference,
2007
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Presentation Outline
• Legislative Framework
• Policy Context• Key strategic challenges
• Focus on key policy areas
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and to “Prescribe mechanisms to enable a co-coordinatedrelationship between private and public health
establishments in the delivery of health services”[S56(1)].
The Minister of Health has the responsibility “to prioritize thehealth services that the state can provide taking intoconsideration health needs and resourcesavailable” (S4 (1)(e)
The
National
Health Act,
2003
“everyone has the right to have access to healthcare services, including reproductive health care”S.27(1)(a)
The Constitutionof the Republicof South Africa
“state must take reasonable legislative andother measures, within its available resources,to achieve the progressive realisation of each of these rights” S.27(2)
Legislative Framework
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Cover Burden of disease Providers
Public
Private
•Indigent
•Low-income
•marginalised
•High income•Good risks
•Poor risks
(decrease)
•HIV/AIDS
•Infectious
•Communicable
•Chronic
•HIV/AIDS
•Infectious (na)
•Communicable (na)
•Chronic (reduced)
•Medical
•Nursing
•Pharmacy
System
POLICY CONTEXT
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Key Strategic Challenges
Fragmentation of the health system, based onseparate financing and provision arrangements
for different socio-economic groups
health care resources available to differentsocio-economic groups within the population
all health care resources between and within
provinces, which has been increasing over thepast few years
financial, human and other resources between the
public and private sectors, relative to the populatio
they serve
G r
o w
ing m
a ld is t rib
u t io n
o f
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Challenges with current financing system
– Private sector: covers 7m people
– Public sector: covers 39m, of which 7m fall outside means test
– Individual households: Out-of-pocket payments
– 7m low income people who cannot afford medical schemes, but do notqualify for free public services, so pay out of pocket
– Out of pocket payment is the most regressive form of health financing
– Inequity: public/private sector
– Inefficiency: excessive expenditure on hospitals
Inadequate Pooling of resources:
Inadequate financial risk protection
Inequity and inefficiencies in financing
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Context: Healthcare Financing, 2006
Public sector
R52 billion
Private sector R66 billion
Serves 7 m
= R9 428 pp
Serves 38 m
= R1 368 pp
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Context: Healthcare Provision in 2004,
Professional
category
Total Public sector
Estimated
dependants
34 611 781=82%
Private sector
Estimated
dependants
7 597 709= 18%
Public:
private ratio
General
practitioners
19 729 5 398=27.4% 14 331=72.6% 1:2,65
Medical specialists 7 826 1 938=24.8% 5 888=75.2% 1: 3,04
Dentists (including
specialists)
4 269 316=7.4% 3 953=92.6% 1: 12,51
Pharmacists 4 410 1 047=23.7% 3 363=76.3% 1: 3,21
Physiotherapists 3 406 463=13.6% 2 943=86.4% 1: 6,36
Occupationaltherapists 1 986 388=19.5% 1 598=80.5% 1: 4,12
Speech therapists
and audiologists
1 388 119=8.6% 1 269=91.4% 1:10,65
Dental therapists 306 121=39.5% 185=60.5% 1:1,53
Psychologists 3 808 222=5.8% 3 586=94.2% 1:16,15
Distribution of Health Professionals in the South African Health Care System (2004)
Source: Health and Health Care in South Africa (2004)
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Partial Social Security Universal Social Securi
Key Issue: 1
– Universally available basic benefit for all citizens and specified classes of legal resident
– Contributory environment over-and-above pillar 1, characterized by strongmechanisms to ensure social solidarity:
• Income-based cross-subsidies
• Risk-related cross subsidies
• Mandatory participation
– Discretionary social security over-and-aboveminimum levels re arded as essential
Pillar 1:
Pillar 2:
Pillar 3:
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Key Issue: Pillar 2
Out of Pocket Spending Prepayment
Income
Lo w ris k
Health risk
Hig h ris
k
X-subsidy from low to high risk X-subsidy from rich topoor
Ric h
Po o
r
Lo w ri s
k
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Specific Issue: Access to Private Health Care
• The MSA sought to promote non-discriminatory access to
privately funded health care through –
– Open enrolment
– Community rating
– Protecting a core set of benefits from arbitrary attrition
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Specific Issues: Access to Private Health care
• The major objective has been met but there are still concerns
involving the following:
– very limited growth in overall number of covered lives
– open enrolment for high risk individuals being frustrated through
indirect discrimination
– inappropriate benefit design– potential fragmentation of risk pools
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Reform of the Medical Schemes Industry
Legislative Development from 2007- Medical Schemes Amendment Bill
- Introduction of the Risk Equalisation Fund
- Restructuring of the Benefit design
- Strengthening of the Governance framework
- Introduction of the general framework for low income products
- The Bill will be tabled in Parliament before the end of 2007
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Contribution Protection Mechanisms?
• As a result of the escalation of the cost of health care, we are in
a process to:
• Create a statutory framework for effective pricing negotiationsbetween funders and health care providers.
• Extensive consultation as soon as clear proposal are in place.
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Health Technology Appraisal
• Draft Regulations on Health Technology in2008/9
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Public Private Partnerships
- Build Operate Transfer where the private sectors builds and operates a
new facility for a given period of time and then transfer it tothe public sector at the end of the concession period
- Build Transfer Operates that is where the transfer of the facility to
the government would take place as soon as the construction is
completed, rather than at the end of the concession period and
– Revitalise Operate and Transfer where the private sector could
rehabilitate the existing public health facilities at its own risk, and then
operates and maintains the facility at its own risk for a given period
– We are working with the National Treasury to prepare concrete proposals
for consultation.
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Infrast ru
ctur e
developm
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Delivery of clinical services
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3
frastructure v/s Service Delivery: PPPs
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Achieving Millennium Dev’t Goals
• The Millennium Development Goals (MDG’s) have set clear targets and goals for eradicating poverty and related human
deprivations.
• The MDGs include 8 goals, 18 targets and 48 indicators: 3 of thegoals, 8 of the targets, and 18 of the indicators relates directly to
health
• Creating a standard reporting and evaluation framework for thepublic and the private health sector.
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THANK YOU
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