Netcare CEO said mandatory medical cover for formally employed people can help lift the burden on the public sector's shoulders. Picture: iStock
Different stakeholders of the Hospital Association met under one roof to discuss ways to improve South Africa’s healthcare quality.
The Hospital Association of South Africa (Hasa) Conference held in Sandton on Monday also looked at ways in which the private sector can help unburden the public sector, as most of the citizens depend on it.
Dr Richard Friedland, Netcare CEO said while waiting for the implementation of the National Health Insurance (NHI), health cover can be made mandatory for formally employed people.
Dr Friedland views mandatory medical coverage as a viable solution to help the public sector. This can also increase public per capita spend on health, and free up resources that could help address the country’s most pressing health crises.
The mandatory medical cover comes on the heels of most South Africans’ struggle to access quality healthcare services, due to different challenges such as neglect of infrastructure, shortage of staff and lack of resources.
“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 million people (56% of the population) dependent on public health resources,” said Friedland.
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While delivering his keynote address, he said they are willing to work hand in hand with the government to find workable solutions to the country’s healthcare challenges. He noted that mandatory medical cover has been researched over two decades.
“The mandatory medical cover is a workable solution that if implemented will be quick to roll out and in a very short time provide enhanced healthcare to all South Africans.”
He acknowledged that the African National Congress (ANC) in its 1994 Health Plan made a recommendation – a mandatory medical cover for the formally employed – and in 1997, the National Department of Health Social Health Insurance Working Group 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.”
Dr Friedland said one of the benefits of mandatory medical cover for the formally employed population would be an increase in public health per capita spend, which could increase by 52% without any additional funding from the public sector budget.
“The latest per capita public expenditure based on a consolidated health budget of R271 billion works out to R5054, 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.”
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He is of the view the successful implementation of the mandatory medical cover for formally employed people could be done in 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.”
He explained that 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%.
In phase 3, there will be an expansion of the economy through recovery and an increase in employment.
“The health system stands to benefit in more immediate and visceral ways. The reduced load on the public sector will result in a reduced burden on doctors, nurses and other healthcare workers, will reduce overcrowding, and free up funding to fix infrastructure, fund unfunded medical posts, and grow our medical skills training capacity – we have a shortage of 27 000 nurses in South Africa, and this is expected to grow to 70 000 by 2030.”
He said the scheme has worked in 61% of African countries. Bringing it to South Africa, he said, the private hospital sector is always on standby to explore the ideas that would result in lessening the load on the shoulders of the public sector for those who need to access quality healthcare.
“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.”
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Dr Friedland said they refused to sign the Health Compact because it is a unilateral compact, and not collaborative. They care deeply about quality healthcare delivery, therefore they believe this can be achieved through a collaborative compact.
“We have written to relevant stakeholders informing them of our desire to participate in a health compact, but it needs to be in a collaborative way.” He added that they are willing to sit down with the relevant stakeholders to reach an agreement that will work for everyone involved, keeping in mind that this is for the betterment of South Africans.
Business Unity South Africa (Busa), the South African Medical Association (SAMA) and the South African Health Professionals Collaboration (SAHPC), which represents about 25 000 doctors, all refused to sign the Health Compact in its current form because they were expected to sign a document that refers to NHI 25 times.
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