Induction

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					Welcome
Hasa Conference 2010



  Healthcare Funding and Doctors in SA
                   By
           Dr Norman Mabasa
            Chairman: SAMA
The 10 Point Plan




   Provision of Strategic leadership and creation of
    a social compact for better health outcomes; (1)
   Implementation of National Health
    Insurance(NHI); (2)
   Improving the Quality of Health Services; (3)
   Overhauling the health care system and improve
    its management; (4)
Continue….




   Improving Human Resources Management, Planning and
    Development; (5)
   Revitalization of infrastructure; (6)
   Accelerated implementation of HIV & AIDS and Sexually
    Transmitted Infections National Strategic Plan 2007-11 and
    increase focus on TB and other communicable diseases;
    (7)
Continue…




   Mass mobilization for better health for the population; (8)
   Review of the Drug Policy; (9) and
   Strengthening Research and Development (10)
Human Resources



   Doctors: 31 330 (end of 2004) now 34 500
   Nurses: 184 459
   Pharmacists: 10 218 (in 2005)
   Not all clinically active
   Some work outside the country
   Many in private practice
Health Workers Outside SA



              Practitioners   Nurses/Midwives Others   Total

Australia     1 114           1 085           1 297    3 496

Canada        1 345           330             685      2 360

New Zealand   555             423             618      1 596

U.K           3 625           2 923           2 451    8 999

U.S.A         2 282           2 083           2 591    6 956

TOTAL         8 921           6 844           7 642    23 407
Public Hospitals per Province (2006)



Province         Beds             Hospitals
Eastern Cape     18 998           94
Free State       6 875            33
Gauteng          16 595           28
KZN              28 322           73
Limpopo          11 977           47
Mpumalanga       4 263            27
North West       5 652            26
Northern Cape    1 859            27
Western Cape     10 018           58
Total            104559           413
GDP and Health Outcomes of Selected
Countries



Country        GDP ($) 2008    Life Expectancy        CMR 2007      MMR 2005
Brazil         $8,400     1    72                1    21.7     1    110    1
Botswana       $6,808     2    50                5    39.7     2    380    3
SA             $5,685     3    50,               4    59       3    400    5
                               53.5 Males
                               57.2 Females
Angola         $4,627     4    42                9    158      4    1400   8
Namibia        $4,051     5    53                3    68       5    210    2
Swaziland      $2,242     6    40                10   90.9     6    390    4
India          $1,068     7    64                2    71.8     7    450    6
Lesotho         $804      8    42                7    83.5     8    960    7
Afghanistan     $500      9    44                6    257      9    1800   9
Sierra Leone    $351      10   42                8    261.80   10   2100   10
Population 2004 and 2009



PROVINCE        2004         2009         % CHANGE
Eastern Cape    7.081.164    6.648.600    -6.1%
Free State      2.934.956    2.902.400    -1.1%
Gauteng         8.851.455    10.531.300   19.0%
KwaZulu Natal   9.643.428    10.449.300   8.4%
Limpopo         5.543.806    5.227.200    -5.7%
Mpumalanga      3.261.062    3.606.800    10.6%
North West      3.820.102    3.450.400    -9.7%
Northern Cape    885.146     1.147.600    29.7%
Western Cape    4.565.487    5.356.900    17.3%
Grand Total     46.586.607   49.320.500   5.9%
 Population 2004 and 2009



12,000,000.00                                                                          35.00%

                         19.00%   8.40%
                                                                                       30.00%

10,000,000.00
                                                                                       25.00%


                                                                                       20.00%
 8,000,000.00

                                                                                       15.00%


 6,000,000.00                             -5.70%                              17.30%   10.00%    2004

                                                            -9.70%                               2009
                                                                                       5.00%

 4,000,000.00                                      10.60%                                        % Change
                -1.10%                                                                 0.00%


                                                                                       -5.00%
 2,000,000.00
                                                                     29.70%
                                                                                       -10.00%


           -                                                                           -15.00%
Challenges To be done




   Existing documents being perused
   MAC to present document to Minister
   Minister presents to cabinet
   Cabinet publishes for comment
   We all now get involved
Ministerial Advisory Committee




   MAC currently deliberating vigorously
   Existing documents being perused
   MAC to present document to Minister
   Minister presents to cabinet
   Cabinet publishes for comment
   We all now get involved
MAC Activities - Advisory




   Committee comprises members from stakeholders to serve
    for 5 years appointed in their individual capacity
   Monthly meetings
   Confidentiality as no concrete proposals or agreements
    have been reached
   No need for multi-stakeholder involvement at this stage
   Preparations for debate essential
   Constructive criticism paramount
Stakeholder Input




   MAC listens to comments
   MAC advises the minister on comments
   Minister takes it back to cabinet for decision
   Currently no advise given yet on proposals
   Details and not timelines to drive the pace
What is NHI?




   New funding model
   New health card for all registered persons
   Introduction of new payment system in both public and
    private healthcare system
   Healthcare free at point of service with a single payer
    system
   No word on private cover yet
   Scope of cover currently being worked on
Current System




   Medical aid covering the employed for private healthcare
   State looking after all citizens, employed and unemployed,
    covered and uncovered, „free at the point of service‟
   Both systems replete with deficiencies and excesses
   Both systems suffer from misallocation of funds and either
    over-service or under-service
Points of Common Course




   NHI is and can be a good concept
   NHI will be implemented at some stage
   NHI works in other countries very well
   NHI could assist in repairing current ills
   Current models in both private and public can be criticised
   Too powerful private system for few
   Too weak public sector for majority
After Document is published




   This requires engagement and more information
   Engagement involves all role-players
   Role-players are the public, service providers as well as
    government
   More info regarding source of funds and administration
    thereof
   More information regarding the scope and range of
    services to be covered
Information Needed




   Where will the funds come from and how much is needed?
   Will people still be free to have private cover?
   What is the range of services to be covered
   Does it include primary, secondary and tertiary care
    services
   What are the limitations or exclusions?
Information Needed continue ….




   How will it work in the public sector where people currently
    do not necessarily pay?
   How will claims be submitted and processed
   How will the current medical aid members benefit?
   Will they get less benefits than they have at the moment or
    will the get same or more?
Public Input Needed




   Will administration costs be less than the current private
    sector admin fees?
   Will there be new administrators who may need fresh
    training?
   Who do you cover?
   How do you delineate districts and sub-districts?
   Any scheme mergers?
Who are the Service Providers



   Hospitals- public and private
   State clinics
   Pharmacists
   General Practitioners
   Specialists
   Nurses
   Traditional Healers have also show greater interest
   Allied Health Professionals, optometrists, physios etc
   RAF and COIDA
Relationships




   Buyer – seller relationships not defined so far
   How much the system costs will depend on how much each
    service provider will accept as remuneration
   Private sector buy their pharmaceuticals and equipment
    using their own funds
   The natural question will be how these will be compensated
    for their „investment‟ or expense
Relationships




   Definition of „accredited facilities may need to be revisited
   What does it mean multidisciplinary practices?
   How about PPPs?
   Will patients have increased or decreased access points?
   How will prices be determined for each provider?
Legislation effected by NHI




   CONSTITUTION OF THE REPUBLIC OF SOUTH AFRICA
    ACT,108 OF 1996
    Pertinent sections provide for the rights of access to health
    care services, including reproductive health and emergency
    medical treatment.
   NATIONAL HEALTH ACT, 61 OF 2003
    Provides for a transformed national health system for the
    entire Republic
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   MEDICAL SCHEMES ACT, 131 OF 1998
    Provides for the regulation of the medical schemes industry
    to ensure consonance with national health objectives.
   MENTAL HEALTH CARE ACT, 17 OF 2002
    Provides a legal framework for mental health in the
    Republic and in particular the admission and discharge of
    mental health patients in mental health institutions with
    emphasis on human rights for mentally ill patients.
Continue…



   CHOICE OF TERMINATION OF PREGNANCY ACT, 92
    OF 1996 AS AMENDED
    Provides a legal framework for termination of pregnancies
    based on choice under certain circumstances.
   STERILIZATION ACT, 44 OF 1998
    Provides a legal framework for sterilization, also for
    persons with mental health challenges.
Continue…



   SA MEDICAL RESEARCH COUNCIL ACT, 58 OF 1991
    Provides for the establishment of the SA Medical Research
    Council and its role in relation to health research.
   TOBACCO PRODUCTS CONTROL AMENDMENT ACT,
    63 0F 2008
    Provides for the control of tobacco products, prohibition of
    smoking in public places and advertisements of tobacco
    products as well as sponsoring of events by the tobacco
    industry.
Distribution of Public Health Facilities in
South Africa



South Africa                 Number of Facilities (200)   Population per Health
                                                          Facility
Clinic                       3595                         13 718
Community Health Centre      332                          148 553
District Hospital            264                          186 817
Nat. Central Hospital        9                            5 479 966
Prov. Tertiary Hospital      14                           3 522 835
Regional Hospital            53                           930 560
Spec. Psychiatric Hospital   25                           1 972 788
Spec. TB Hospital            41                           1 202 919
Grand Total                  4333
Number of Facilities vs Population




10000                                                                                                                                 6000000



                                                                                                                                      5000000

                                                                                                                                                Number of
                                                                                                                                      4000000   Facilities
                                                                                                                                                (200)


  100                                                                                                                                 3000000
                3595              332            264                                                                                            Population
                                                                                                                                                per Health
                                                                                                                                                Facility
                                                                                                                                      2000000

                                                                                                        1972788
                                                       5479966




                                                                                 14
                                                                                                   53             25
                                        186817




                                                                     3522835




                                                                 9


                                                                                                                       1202919
                         148553




                                                                                                                                      1000000
                                                                                          930560
        13718




                                                                                                                                 41


    1                                                                                                                                 0
                Clinic    Community District               Nat. Central         Prov.         Regional   Spec.     Spec. TB
                            Health  Hospital                Hospital           Tertiary       Hospital Psychiatric Hospital
                            Centre                                             Hospital                 Hospital
It is clear that more time will have to be spent on
engagement than has already been spent on
conceptualisation
Agreements are more crucial at this stage and as it looks
now work has not even begun to be teased on relationships
and identification of all role-players
More time well-spent will achieve better results than when
this system is implemented in haste and result in worse
disaster than is currently experienced
Admittedly citizens will expect better than they have now
and we all therefore have to manage expectations candidly
We need to tell whether all will get equal by getting less or
whether all will get same by getting better
Whilst we are all tired of the inadequacies of the current
system, it does not automatically follow that the
replacement is better by default
It is not about how good the intention is, it is about how well
it is executed
It is not about how nice the garment looks, it is about how
appropriately it fits the body frame
It is not about how successful the system is in other
countries, it is about how well they planned for it, it may
also include how long they took to plan and make it work
Time well-spent on this may be just the only remedy we
need for its successful implementation
If its done in haste we may end up failing a success we
should never have faultered
Remember „Working Together We Can do More‟
“Let he that has got ears listen and he that has eyes see but
                  he that has both wisen up”

                        Thank You