Healthcare’s a right, not a commodity

2011-07-09 10:26

In her address to the United Nations on advancing global health in June 2009, the director-general of the World Health Organisation (WHO), Dr ­Margaret Chan, famously ­remarked: “A health system is a ­social institution. It does not just ­deliver pills and babies the way a post ­office delivers letters. Properly managed and financed, a health system that strives for universal coverage contributes to social cohesion and stability.”

Let me begin by indicating that as a department, our approach to healthcare is informed by the sacred declaration in our Constitution that healthcare, just like shelter and food, is not a privilege but a basic human right that must be protected by the state.

In the health sector, the rampant and free-for-all patient billing system currently prevailing in the private health sector which was the subject of intense public debate over the past week undermines this fundamental right.

This state of affairs is unacceptable and serious intervention is ­required to remedy the situation and put our health system on a caring and ­progressive trajectory.

The current debate on how private healthcare levies fees on the patients they serve is a case in point. A few individuals have accused me, as the minister of health, of running away from the crisis of quality in public healthcare by what they allege is an attack on the private sector.

I have been frank and forthright in my admission and acceptance of the crisis in quality healthcare that ­public hospitals are suffering. I want to admit upfront that public hospitals have extraordinary ­challenges as far as healthcare ­quality is concerned.

Hence, we are embarking on several far-reaching processes outlined in our 10-point programme to deal with this unsavoury state of affairs. The plan clearly states that we need to improve the quality of healthcare. Point four of the plan states that we need to overhaul the entire healthcare system and improve its management.

Consequently, we are in the process of establishing an office of standard compliance which will be ­responsible for basic standards in our healthcare institutions, including patients’ safety and security, staff ­attitudes, infection control, long queues and waiting times in public hospitals, and drug stock-outs.

All these initiatives are undertaken with a tacit acceptance that there are problems in the public healthcare system.

These problems, however, are not a licence for the private healthcare sector to mercilessly levy fees that will bring our people to their knees on the basis that they have nowhere else to go.

I want to remind people that I am not the minister of the public health system but minister of health, ­responsible for both public and private. So when there are problems in the public health sector I accept them and intervene, as I am doing.

Equally, when I notice problems in the private healthcare system, I must intervene without fear or favour and that is why I raised this debate.

There is a false belief that the fees levied are only a problem for those who pay cash for services. This is a fallacy because those who are on medical aid schemes are charged so exorbitantly that some schemes are virtually bankrupt and members’ benefits are exhausted long before the end of the year, leading to a situation where they remain uncovered while they continue contributing.

To drive my point home, in 2009/10 claims made by service ­providers in the main private hospitals to medical schemes outweighed members’ contributions by R2.5 billion. It is evident from this state of affairs that the private healthcare ­industry is unsustainable.

As I indicated at labour federation Cosatu’s central committee meeting, an uncontrolled increase in healthcare costs has a “knock-on” effect on contribution increases, leading workers to believe that they are short-changed by their employers on the medical aid subsidy portion of their salaries.

This inevitably leads to protracted wage negotiations, ending up ­contributing handsomely to wage ­inflation in the entire economy.

Our position as government is that health is a social service and not a commodity. This is what the state sector understands.

Unfortunately, with the situation what it is ­today, the private health sector does not share this perspective with the state sector. To the private sector, health is a market commodity to be traded in the stock exchanges of this world. I beg to differ.

The state recognises the fact that the provision of section 27(2) of the Constitution is sacrosanct: health is a basic human right that cannot be sacrificed on the altar of profiteering by those who command massive ­resources.

South Africa spends 8.5% of its gross domestic product (GDP) on health. The WHO recommends that 5% of GDP should be spent on health. However, the manner in which this 8.5% is distributed among the citizens of this country is so skewed it is ­unacceptable.

It is scandalous that 5% of the 8.5% is spent on only 14% (seven million people) of the population. These are those of us with medical aid. The remaining 3.5% is shared among 86% (42 million) people.

Since this portion of the GDP is made up of both the public and private sector, it explains why South Africa spends more on health, but with poorer outcomes, than countries which spend much less.

The 42 million people who have no medical aid are overwhelmingly serviced by the public sector. Before the 1994 democratic dispensation, South Africa had two health systems, a superior one for the minority white population and an inferior one for the majority black population.

Our democratic Constitution abolished this madness. However, we have strangely ended up with two systems once again: one for the rich and middle class who have medical aid, and another for the poor.

To remedy the situation, we ­require a national health insurance ­programme which will end this shameful discrimination ­between rich and poor.

Its objective is to merge these two mutually exclusive systems into a unitary, coordinated system that can equitably service all South Africans, irrespective of class.

It endeavours to pool national ­financial resources to service the citizenry without discrimination based on social standing.

There are those who want us to ­believe that the private healthcare ­industry could regulate itself. The cold and harsh reality is that it is ­incapable of doing so. The industry is driven by profit and the shareholders of these ­companies demand more profit ­every year from their ­investments.

How can we justify a circumcision which costs R15 000, drainage of an ordinary ischiorectal abscess for R30 000 and a laparotomy to remove an intra-abdominal abscess which costs R500 000? Can cleaning someone’s womb possibly cost R18 000?

The time has come to save our country from this law of the jungle in which the weak and vulnerable are pulverised by the rich and powerful.

» Motsoaledi is the Minister of Health

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