Motsoaledi has a new jab at regulating medics

The Health Department's controversial plan to use a "certificate of need" to regulate where doctors work was among
proposalscontained in the White Paper on National Health Insurance, Health Minister Aaron Motsoaledi
has told delegates to the annual Hospital Association of SA conference.

Business Day, 22 September 2015

The department has for years tried to introduce a policy that directs healthcare resources to where they are most needed, but has repeatedly run into obstacles. In January, the Constitutional Court agreed to a request by the Presidency that it set aside a proclamation bringing into effect sections 36 to 40 of the National Health Act, which required all health establishments, including doctors' practices and private hospitals, to obtain a certificate of need.

The Minister said the only reason the law was withdrawn was because it was very badly written. He said that it is in the White Paper, adding that he does not understand why people regard it as a monster. The Hospital Association of SA represents private hospitals and its annual conference gathers some of the most influential players in the private healthcare sector. Motsoaledi was silent on private sector prices, on which he usually pulls no punches. But he signalled a strong role for the private sector in National Health Insurance, saying the government envisaged "utilising both the public and private healthcare space".

He said he was puzzled by the public's response to the Gauteng health department's proposal to treat some public sector patients in private hospitals. He said work on the National Health Insurance White Paper was complete, and he was waiting for an invitation to brief the Cabinet. Motsoaledi urged the private healthcare sector to devise new business models to help SA "leapfrog" to a new paradigm. Referring to discussions at this year's World Economic Forum in Davos, Switzerland, he said emerging economies had the opportunity to build new health systems and leap past many of the problems that plague healthcare systems in developed economies.

Motsoaledi called on South Africans to shift their debate on whether the NHI was affordable, saying instead the question should be whether the country could afford not to have the universal healthcare. He said since the proposal of the universal scheme, some including those in the private healthcare had been sceptical, arguing that there was no way the country could afford the flagship programme as South Africa was not a rich nation. Some in the medical fraternity were so opposed to the scheme that they threatened to leave the country and work in other parts of the world. But Motsoaledi said although some in South Africa wanted to run away from the NHI, the world was embracing universal healthcare. As evidence of this "world embrace" the UN General Assembly was this week set to discuss universal healthcare as one of its sustainable development goals to replace the millennium development goals, which came to an end this year.

Pretoria University's dean of health sciences, Eric Buch, said the national health pilot project, launched in 2011, had strengthened the public health system in the 11 districts in which it was running, but had yet to experiment with approaches to financing and contracting. Buch suggested that the Treasury create two conditional grants for pilot sites, one for strengthening health systems and the other for experimenting with models for purchasing services. One of the biggest challenges for private healthcare was winning the trust of government, he said.

Buch said there are many influential people in the National Health Insurance policy environment who do not feel the private sector can be trusted to deliver affordable health services in private hospitals for the poor.