Transcript Key issues facing the health sector in the next five years

Key issues facing the health sector
in the next five years
Thabo Rakoloti
Director: Public Private Partnership
National Department of Health
The BHF Annual Southern African Conference,
2007
Presentation Outline
•
•
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Legislative Framework
Policy Context
Key strategic challenges
Focus on key policy areas
Legislative Framework
everyone has the right to have access to health
care services, including reproductive health care”
S.27(1)(a)
“
The Constitution
of the Republic
of South Africa
“state must take reasonable legislative and other
measures, within its available resources,
to achieve the progressive realisation of each of these
rights” S.27(2)
The
National
Health Act,
2003
The Minister of Health has the responsibility “to prioritize the
health services that the state can provide taking into
consideration health needs and resources
available” (S4 (1)(e)
and to “Prescribe mechanisms to enable a co-coordinated
relationship between private and public health
establishments in the delivery of health services”
[S56(1)].
POLICY CONTEXT
System Cover
Public
•Indigent
•Low-income
•marginalised
Burden of disease
•HIV/AIDS
•Infectious
•Communicable
•Chronic
Providers
•Medical
•Nursing
•Pharmacy
Private
•High income
•Good risks
•Poor risks
(decrease)
•HIV/AIDS
•Infectious (na)
•Communicable (na)
•Chronic (reduced)
Key Strategic Challenges
financial, human and other resources between the
public and private sectors, relative to the populations
they serve
health care resources available to different socioeconomic groups within the population
all health care resources between and within
provinces, which has been increasing over the past
few years
Fragmentation of the health system, based on
separate financing and provision arrangements for
different socio-economic groups
Challenges with current financing system
Inadequate Pooling of resources:
– Private sector: covers 7m people
– Public sector: covers 39m, of which 7m fall outside means test
– Individual households: Out-of-pocket payments
Inadequate financial risk protection
– 7m low income people who cannot afford medical schemes, but do not
qualify for free public services, so pay out of pocket
– Out of pocket payment is the most regressive form of health financing
Inequity and inefficiencies in financing
– Inequity: public/private sector
– Inefficiency: excessive expenditure on hospitals
Context: Healthcare Financing, 2006
Public sector
R52 billion
Serves 38 m
= R1 368 pp
Private sector
Serves 7 m
R66 billion
= R9 428 pp
Context: Healthcare Provision in 2004,
Distribution of Health Professionals in the South African Health Care System (2004)
Professional
category
Total
Private sector
Estimated
dependants
7 597 709= 18%
14 331=72.6%
Public:
private ratio
19 729
Public sector
Estimated
dependants
34 611 781=82%
5 398=27.4%
General
practitioners
Medical specialists
7 826
1 938=24.8%
5 888=75.2%
1: 3,04
Dentists (including
specialists)
Pharmacists
4 269
316=7.4%
3 953=92.6%
1: 12,51
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
Occupational
therapists
Speech therapists
and audiologists
Dental therapists
1 986
388=19.5%
1 598=80.5%
1: 4,12
1 388
119=8.6%
1 269=91.4%
1:10,65
306
121=39.5%
185=60.5%
1:1,53
Psychologists
3 808
222=5.8%
3 586=94.2%
1:16,15
Source: Health and Health Care in South Africa (2004)
1:2,65
Key Issue: 1
Partial Social Security
Universal Social Security
Pillar 1:
– Universally available basic benefit for all citizens and specified classes of legal
resident
Pillar 2:
– Contributory environment over-and-above pillar 1, characterized by strong
mechanisms to ensure social solidarity:
• Income-based cross-subsidies
• Risk-related cross subsidies
• Mandatory participation
Pillar 3:
– Discretionary social security over-and-above
minimum levels regarded as essential
Key Issue: Pillar 2
Prepayment
Out of Pocket Spending
X-subsidy from low to high risk
Health risk
X-subsidy from rich to poor
Income
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
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
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
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 negotiations
between funders and health care providers.
• Extensive consultation as soon as clear proposal are in place.
Health Technology Appraisal
• Draft Regulations on Health Technology in
2008/9
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 to
the 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.
Infrastructure v/s Service Delivery: PPPs
100%
Infrastructure development
3
2
1
0%
0%
Delivery of clinical services
100%
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 the
goals, 8 of the targets, and 18 of the indicators relates directly to
health
• Creating a standard reporting and evaluation framework for the
public and the private health sector.
THANK YOU