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Since 1994, South Africa has invested substantial resources in health services. As a result, he has made significant health gains. For example, nearly 4 million people are receiving HIV treatment and mother-to-child transmission has almost been eliminated.
The provision of services has also been considerably extended to more than 4,000 health facilities. And there has been a significant increase in the number of health professionals.
But the need for health care is not static. For example, noncommunicable diseases such as diabetes and hypertension are now responsible for more deaths than HIV and TB combined. And in some cases, successes have created challenges. For example, the expansion of HIV treatment means that there is now a large cohort of chronic patients requiring continuing care. In addition, the reality of a largely young population requires interventions so that health gains are not lost.
Health services in South Africa are provided by a large public health system as well as by highly sophisticated private health providers. Funding in the public sector has been steadily declining over the last six years. The result is that public health services are increasingly under pressure and unable to provide adequate care for the poor, especially those living in rural areas.
The private sector has also been under pressure. This has led to price increases, making many medical aid systems unaffordable. The number of members is not progressing, partly because of the country's very high unemployment rate – membership in medical aid is tied to formal employment. The result has been even more pressure on the public sector.
Reform is clearly needed. All that is in dispute is what it should look like.
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The publication of the National Health Insurance Bill is the government's response to the problem. The plan's central plan is a national health insurance fund that will buy health care services from health professionals and deliver them to public and private institutions.
The bill has attracted a lot of criticism, including financial concerns. that it will not fix the public system that collapses. But I believe that more fundamental questions need to be asked: Does this meet the goal of providing universal access to health care for all South Africans? And can it do it in a way that does not lead to catastrophic expenses?
The answer to these two questions I think is yes.
Breaking with the Past
Despite the shortcomings of the bill, it has two great merits
The first is that it addresses the country's current approach to health care where the quality and type of services people receive are more influenced by their socio-economic status than by their need for care. Instead, it takes a population-based approach. This means that budgets would be allocated based on the number of people living in a region and their disease profiles and health care needs.
If this approach is properly applied, health costs will decrease over time. The second major merit is that it examines health services from three perspectives:
This means that it separates those who buy the health services from those who will deliver the health services.
An Orientation Change
The bill also promises to transform the way money is spent on health care because it aims to separate the supply and delivery health services. This has two advantages.
First, it will mean that health budgets are allocated more efficiently based on health needs rather than purely on the use. Second, it can potentially unlock significant savings through strategic purchases.
The country spends a little less than half a trillion rand for combined public and private health care. But funds are not allocated and spent effectively.
For example, almost half of the funds spent on primary care services are devoted to the care of patients with chronic HIV. While spending to maintain access to HIV care is important, funds must be allocated to treat noncommunicable diseases that are becoming an increasingly important public health threat.
Private sector services have their own problems. The main of them is that its approach is curative – that is to say treat people in hospitals – rather than preventive.
The bill provides that primary health care facilities will become the main point of entry for all patients. Another advantage of the proposed system is a more equitable distribution of services.
There are currently more than 4,000 public health facilities serving more than 80% of the population's primary health care needs. In the private sector, there are nearly 5,000 general practitioners who meet the health needs of only 16% of the population. Most are concentrated in urban areas
Rural residents are therefore largely dependent on a public sector with insufficient resources.
At the heart of the proposed universal health system is the promise that everyone will have access to health.
By Strengthening the Health Care Market, the Bill Opens the Door to More Equitable Resource Allocation
If implemented successfully, this approach offers a real opportunity to stay healthy. to tackle the gross inequalities of the country. access to health services
A marathon, not a sprint
The national health insurance should be seen as an opportunity to carry out the necessary health care reform in South Africa. But South Africans need to realize that the implementation of this new highly complex system will look more like a marathon than a sprint.
The final implementation of national health insurance is still far away – two more phases are planned. And the publication of the bill is only the first legislative step. Over the next four years, another 12 pieces of legislation should be adopted.
South Africans should be patient
Russell Rensburg is responsible for the Health Systems and Policy Program at the University of the Witwatersrand.
This article was published with permission of The Conversation. The original publication can be viewed here.
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