26 September 2013

Barriers in SA healthcare need to be broken down

Strong partnerships between the public and private sector need to be built if South Africans want to achieve optimum health.


The clear divisions between public and private healthcare in South Africa need to be broken down, and strong partnerships between the public and private sector need to be built if we want the nation to achieve optimum health.

This was the clear message from Dr Anban Pillay, Deputy Director General Health Regulatory and Compliance Management at the National Department of Health. He was speaking at the 14th Annual conference of the Board of Healthcare Funders (BHF), held in Cape Town recently.

Standard treatment guidelines

Dr Pillay called for medical schemes to partner with government to come up with evidence-based, defendable, standard treatment guidelines.

“Any partnership needs to focus on healthcare,” he said. “The problems come in when it is a purely financial arrangement. We need to ensure that we build long term relationships that are developed on mutual respect.” 

Dr Pillay emphasised that the strengths of both sectors needed to be taken into account. “Too often we focus on the weaknesses, and by so doing, we sell ourselves short,” he said.

For Dr Pillay, one of the major strengths of the private healthcare sector is the purchaser-provider split which provides a healthy tension and allows both purchasers and providers to hold each other to account. In the public sector, it is important to recognise that South Africa is a leader in medicine procurement. The State is also able to provide many services at lower cost and public hospitals could be used by the private sector for selected cases far more often than is currently the case.

Private sector patients at risk

He also warned that private sector patients were at risk because of a perception that free vaccinations and family planning were for public sector patients only.

“It doesn’t bode well for us if we have a section of the population unvaccinated because they think they are not eligible for the free service,” he said.

“Private patients say they are worried about the quality of care in the public sector,” he said. “In my opinion, their concerns are actually about aesthetics. These are not insurmountable challenges and a long term partnership can solve this.”

Amending legislation

Dr Pillay suggested that one solution would be if the Public Works Department had an oversight role rather than actually repairing and maintaining health facilities.

He also turned his attention to the fees paid to providers, suggesting that a system which allowed fees collected to be retained to some extent at local level.

“Amending the legislation to make this possible would improve results, as we have seen in the Western Cape,” he said.

The division between the sectors also opens the door to fraud.

“The medical schemes sit on data about how much they pay providers,” he said. “It surprised us how many full-time state employees deliver services to private as well. The extent to which they are being paid is significant. We need to work together to break the perception that the one sector doesn’t talk to the other, which leads people to believe they can get away with things.”


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