At the Hospital Association of South Africa (Hasa), we believe that there is an art to seeing beyond what is, to what could be. It’s not always easy. And it takes more than just practice.
Any healthcare reforms, including the proposed National Health Insurance (NHI), must have high-quality patient care as the primary objective.
This motivation lies behind the Hospital Association of South Africa (Hasa) urging that some objectives in the NHI Bill need revisiting.
For instance, if the proposed Fund experiences financial problems in the future, these will affect all healthcare institutions on the frontlines and impact patient care directly. If we are serious about patient-centric care, we must pay attention to the design and oversight of the proposed Fund.
It is better to anticipate the risks to the Fund exhaustively and take appropriate precautions to protect it to avoid putting patients at risk.
We resolutely urge amendments to the Bill in two key respects.
First, it is sadly undeniable that our economy faces massive challenges that will persist for many years into the future, even if we take bold and decisive actions now. The structural reforms we need will take years to complete, and the investments in energy, water, transport and healthcare infrastructure will place a heavy load on the national purse for the foreseeable future.
We can ignore all this, plough into dangerous waters, and expose the country to even more danger, or we can be prudent and gather together around national priorities that everyone can buy into, and the country can afford.
Therefore, to avoid future disruptions to frontline healthcare operations, a single-payer of the healthcare needs of all South Africans and the marginalisation of medical schemes is unwise. Instead, adopt a multi-payer system to alleviate future healthcare funding needs and reduce the potential burden on the National Health Insurance.
This step alone dramatically improves the chances of achieving healthcare reform and expanding universal healthcare. Introducing a multi-payer system reduces future economic risk. It helps manage risks to patient care as the country works to recover from difficult times and reposition itself for future growth.
Secondly, we must build trust to ensure reforms are successful. Thankfully, the government and business leaders are doing great work towards achieving this, but we are not there yet. It is unhelpful to the reform process to hear accusations that thousands of highly dedicated private medical professionals are less motivated to deliver care than profit. Statements to this effect are ill-advised.
Trust requires that we listen to each other so that the best ideas that serve all in our land survive. The downside is partisan rancour, gridlock, and obstruction. We must bypass this negativity.
An excellent place to begin to build trust is to attend to the governance of the proposed Fund. It would help to constitute governance structures and processes that demonstrate what we have learned from the many years of state capture and endemic corruption that have brought the spectre of opportunism on a grand scale to the fore through procurement and administrative fraud.
It is simply not enough to charge South Africans to ignore what has blighted their lives and caused untold misery. Trust must be earned, and it can be if the message sent to South Africa by the Presidency and the Cabinet is that power will no longer be allowed to accumulate in one person’s hand or in the hands of those who can, as they have for years now, pilfer the money pot.
To this end, we advocate for the scrutiny of the governance structures to protect the Fund and the minister of health and to ensure the continued and uninterrupted care of patients when they need us most.