Current role of private sector in South Africas he heal alth th - - PowerPoint PPT Presentation
Current role of private sector in South Africas he heal alth th syste stem m an and p d pot oten enti tial al con ontr tribu ibutions tions an and d cha hall llen enges ges David Sanders Emeritus Professor: School of
David Sanders
Emeritus Professor: School of Public Health University of the Western Cape Honorary Professor: Department of Paediatrics and Child Health UCT
A WHO Collaborating Centre for Research and Training in Human Resources for Health
Tax:
43% of funds 84% of population for primary care, inpatient & specialist care
Out-of- pocket:
13% of funds (16% uninsured use private GP & pharmacy on OOP basis)
Private medical insurance schemes:
44% of funds 16% of population
5 10 15 20 25 30 35 40 Lebanon Jamaica Canada Slovenia France Dominican Republic Zimbabwe Chile Brazil Argentina Bahamas USA Namibia South Africa
Private insurance as % total health care expenditure
WHO National Health Accounts database
The private hospital market in metropolitan areas (50%+ of medical scheme population) was concentrated by 1999..
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% 1996 1998 2000 2002 2004 2006
Percentage of total acute beds
Life Medi-Clinic Netcare Independent
Market becomes concentrated
Only 12.3% of private hospital beds were outside three main hospital groups by 2006…
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0.0 50.0 100.0 150.0 200.0 250.0 300.0 350.0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Real per capita expenditure
Coincides with market concentration
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Drs per 10 000 population
Source: WHO country profile [http://apps.who.int/nutrition/landscape/report.aspx?iso=rwa]
0% 10% 20% 30% 40% 50% 60% Public
Public & private % share
benefits Poorest 20% 2nd poorest Middle 2nd richest Richest 20%
Ataguba and McIntyre (Health Economics, Policy and Law, 2012)
contributes R3 800 per month towards their medical aid. This is 19% of the family’s income. At the current rate of medical aid increase, in 2030, that family will pay 28% of their disposable income;
through general tax revenue allocations, supplemented by –
This funding approach has been developed by the National Treasury with a maximum payroll tax of 4% that will be used to fund NHI. This is also much lower than what poor and rich households pay as their contributions to medical scheme
contributing to medical schemes will be much more positive under NHI Fund; and
social solidarity principle of NHI.
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Public funds:
Tax (general and additional) Whole population entitled to benefit (richest will probably have double cover)
Out-of- pocket:
No fees at point of service
Medical schemes:
? 8%-9% of population
and access to needed care for all legal residents
also ensures that there is a unified national health system that accords our citizens sufficient financial risk protection from catastrophic health-related expenditures and improves the health outcomes of the
private health sectors
When you are sick, you are not prevented from getting care if you do not have the money to pay A Single-Payer system means that there is
that controls the funds, not many insurances Risk: Your likelihood you will need health care Risk-sharing: Those who are healthy (and low risk) pay in more than they use from the fund: The healthy subsidise the sick – because when we are sick, we know we will have services
to serve needs of all South Africans;
benefit entitlement for all; no tax subsidy on medical scheme contributions
Our health facilities are more effective, efficient, accessible and improve health in the country Bring into public facilities many health professionals (e.g. GP Contracting) who work mainly in the private sector Opt-out: I can decide to join the NHI or not What you pay to your medical aid, you can claim as deduction
National Core Standards Ideal Clinic Programme Re-engineering primary health care
Universal Health Coverage: Different Understandings
Universal health coverage (UHC) has the potential to transform the lives of millions of people by bringing life-saving health care to those who need it most. UHC means that all people get the treatment they need without fear of falling into
donors and developing country governments are promoting health insurance schemes that exclude the majority of people and leave the poor behind.
Universal Health Coverage Why health insurance schemes are leaving the poor behind OXFAM, 2013
Healthy life expectancy (HALE) and government expenditure on health as per cent of GDP 2000
HALE 2000 Govt expend on health % GDP HALE 2000 Fitted values .3 2 4 6 8.3 29.5 50 73.8
Mackintosh and Koivusalo 2005
Log of probability of dying before five years and private
expenditure on health as per cent of GDP, 2000
Log (Prob of dying < five years) Private expend on health % GDP Log (Prob of dying < five years Fitted values .3 2 4 6 8 10.1 1.09861 5.69709
Mackintosh and Koivusalo 2005
30 June 2017 WP gives notice of “Implementation Structures” The Advisory Committee On Consolidation Of Financing Arrangements is tasked in the WP with advising Minister “on strategies to be followed in consolidating current fragmented funding pools in the medical schemes environment.” In the July 7th gazette the strategies are already defined:
formally employed in SMEs, the formally employed in big businesses, the informal sector and the unemployed;
sector workers
categories, i.e. when we implement NHI, we have to start with those who are not covered
Interim Insitutional Structure
Civil servants and their dependants (incl. SoEs) 5.5m Formal Sector Employed and their dependants (large business) 12m Formal Sector Employed and their dependants (SMMEs) 6m Informal sector and their dependants 8m Individuals in households with no income or are not employed 24m
income
Only 8.8m of these people have access to health services via medical schemes The central philosophy of Implementation of NHI is to bring into fold those people who are not insured (specifically those who are unable to afford medical scheme cover).
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must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population
incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of
system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level.”
[Bull World Health Organ 2013; 91: 602–611]