WARNING: This is Version 1 of my old archive, so Photos will NOT work and many links will NOT work. But you can find articles by searching on the Titles. There is a lot of information in this archive. Use the SEARCH BAR at the top right. Prior to December 2012; I was a pro-Christian type of Conservative. I was unaware of the mass of Jewish lies in history, especially the lies regarding WW2 and Hitler. So in here you will find pro-Jewish and pro-Israel material. I was definitely WRONG about the Boeremag and Janusz Walus. They were for real.
Original Post Date: 2008-05-11 Time: 00:00:00 Posted By: Jan
Minister of Health Manto Tshabalala-Msimang commented after a tour of Chris Hani Baragwanath hospital several years ago that she would not ever want to have to attend that hospital.
Most South Africans do not have a choice, and one of South Africa’s biggest challenges is to find ways to make a better quality of hospital care available to all South Africans.
The question, however, is should this be done by making the private sector more accessible, or by improving the quality of public health care? The DA believes we need to do both.
The health minister, on the other hand, through her recently released amendments to the National Health Act, has focused on the former. A draft bill recently released by Tshabalala-Msimang proposes a tribunal to negotiate fees for private hospitals.
| ‘hospitals will simply close down and doctors will go elsewhere’ |
Private hospital fees increase at a rate significantly above the inflation rate every year and there is no doubt some action needs to be taken to tame these increases. And the minister’s proposed process will almost certainly have the effect of reducing hospital fees.
However, the minister makes the assumption that this tribunal can bring about steep price decreases and at the same time leave the private hospital sector untouched in all other ways. This will not be the case.
If prices come down to a level that providers cannot sustain, then hospitals will simply close down and doctors will go elsewhere. The minister has already done a considerable amount to help this process along.
When asked in a survey by the Southern African Migration Project in 2007 why they were leaving or considering leaving, 44 percent of the 1 700 practitioners polled said they were unhappy with the health department.
Even if hospitals do not close, they will certainly be more financially constrained, less able to offer many of the services that differentiate them from public-sector hospitals, and less able to assist the public sector with some of the activities they already undertake – such as nursing training, assistance with reducing waiting lists and conducting joint health promotion and screening campaigns.
| ‘It is imperative we work at retaining what is good’ |
The bill also raises numerous problems relating to the legality of the structure of the proposed tribunal. It will be a quasi-legal structure with greater powers than even the police have, and with no appeal or accountability mechanisms.
The tribunal has the right to search any premises and seize any information with no court warrant required. The tribunal members are only to be appointed by the minister, creating an inherent conflict of interest, as the minister has already taken a clear position on the kinds of decisions she expects this tribunal to take.
Members of the tribunal have rights to demand information, require individuals to testify and grant interdicts, powers usually only held by courts and judicial commissions. Finally, there is no appeal to a decision beyond the minister herself, thus excluding the courts from the entire process.
The DA believes it would be more constructive in the long run to look at other ways of cutting the cost of private hospitals, and in particular by creating specific vehicles to give the private sector the opportunity to develop low-cost models of care for the low-income market and for the two sectors to co-operate more closely with each other.
The DA would, for example, develop a system whereby hospital groups wanting to establish private hospitals will be able to generate significant benefits, including subsidies and VAT exemptions, if they choose to adopt one of several options for public private partnership agreements. These would include:
At the same time, the ground needs to be levelled to give private hospitals a better chance of competing on equal terms with the public sector. The state tendering system for medicines, for example, is a severe constraint on a more competitive environment and needs to be changed.
The system currently requires that medicines manufacturers charge extremely low prices to the public sector and compensate for this by loading the prices they charge to the private sector.
This uncompetitive practice must be eliminated, and medicines should be marked at the same price wherever they are sold. However, patients should be able to claim rebates on the cost of these drugs according to the income-based formulas that already apply to public hospital admissions, whereby the poorest patients receive free services, and fees are charged at progressively higher rates according to income.
The effect would be three-fold:
One of the central drivers of above-average inflation in private hospitals is perverse incentives, whereby hospitals are encouraged by the fee-for-service billing model which applies to maximise services to patients and to over-prescribe.
The DA rejects proposals for reforming the health-care system which threaten only to further undermine it. It is imperative we work at retaining what is good about the system we have and, in particular, a public health-care network that is widely accessible and often does provide a high quality of care, and a private sector that provides a world-class service relied on by the working population which drives our economy. We must look for ways to bring these two sectors together, not deepen the divide and shut down important parts of it.