Picture: THINKSTOCK
Picture: THINKSTOCK

Related articles

THERE are a few simple policy reforms that would achieve universal access to healthcare with no additional costs to the fiscus in a much shorter period than the proposed by National Health Insurance (NHI). The government should:

• Provide universal support to every South African citizen and legal resident — on medical aid or not — that funds a comprehensive package of health services in the public health system.

• Drop the means test. Individuals without medical aid can access free healthcare at hospitals. Those with medical aid may use public healthcare, but have their medical scheme pay for it.

• Improve hospital governance by appointing clinically qualified CEOs and give them greater autonomy and accountability as well as build robust firewalls, insulating the appointees from interference.

• Keep health delivery and purchasing with provinces, but support and facilitate their ability to contract with both the public and private sector at agreed rates, based on agreed quality of service ratings.

• Expand our skilled professional workforce and strengthen the training platform by investing in, among other things, the funds set aside for the Cuban training programme, and enhance resource flows for clinical research.

• Introduce a revised framework for provincial logistical services, with cost incorporated into tender prices. Depots are essential, but must be run like businesses, with strong management and procurement services.

• Establish a single emergency number like the US’s 911, underwritten by a critical care fund that supports a public-private ambulance service with performance-managed response rates.

• Reform medical aid schemes to pool-fund their risks, introduce reinsurance for vulnerable schemes and have express prohibitions against any scheme attempting to discriminate on the basis of health status.

These key interventions are a start. We do not need the monumentally expensive NHI to introduce any such public and private sector reforms.

Dr Wilmot James
Democratic Alliance spokesman on health