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
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
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.”
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
“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.”