The health system: a solution

2009-09-03 00:00

I WOULD like the opportunity to reply from the private sector to Karin Volker’s request for five hours of goodwill from private health care practitioners to help out the state hospitals (The Witness, July 30).

I am not too keen on giving up five hours when I am pretty sure that half of that time will be wasted and will not actually be spent on working, due to the inefficiencies in the state hospitals that we are all so well aware of.

If we are really serious about fixing the state health system, I believe the quickest way to improve it is to ban all politicians — from all parties — from using the private medical system. I would also ban all government employees working in the Health Department from using the private medical system.

Politicians (municipal, provincial and national) and Health Department employees must use the state system as John Public does. They must start off by acces­sing health care at the clinic level. They must not be allow­ed to contact friends in high places and gain, for example, direct access to specialist care at Grey’s Hospital.

If the state provides a quality health care service there will be no problem. If the directors or managers have to use the system they will certainly ensure the quality of the system. Many politicians malign the private sector at every opportunity but as soon as they are sick, they make sure they access it posthaste. If they are no longer able to do so they will certainly make sure the practitioners who look after them are paid adequately and have the correct equipment and facilities.

What can we from the private sector really do about helping Volker and her colleagues in the interim until the politicians stop talking and provide real solutions?

The problem is capacity in state hospitals. The private sector has the capacity to provide care.



• The government decides which patients qualify as indigent or eligible to receive care in the private sector (non-medical aid patients).

• These designated patients are issued with some identifying form or card from the local Magistrate’s Office or Home Affairs office.

• The state decides on the number of consults allowed per year and directs patients to approved general practices who are audited to ensure quality care.

• The identifying card allows path tests, x-rays, specialist referrals, hospital care, etc.

• There is no payment by the state to a practitioner. The practitioners are rewarded by a tax rebate for the patients treated.

• Medication is provided by state hospital/local clinics on production of a qualifying card or legalised state prescription.

• If capacity in state pharmacies is a problem, private pharmacies can provide the medicine similarly for a tax rebate. They can obtain supplies from state stores.

• Only medications on a state formulary are provided, according to state guidelines.

• Tax money funds health in any event. This system would ensure efficient use of tax.

• Obviously checks and balances are needed for fraud and corruption but the state can control who has access and no practitioner can earn more money than the tax owed.

Both sectors, public and private, need to get their acts together. There is money in the system for good health care. In the private sector, of the medical aid pie, 20% of the subscriptions are spent on non-medical endeavours — that is admin­istration, brokers etc. Four percent of the pie goes to general practitioners and five percent to specialists. The rest goes to hospitals and pharmaceuticals. After the recent desperate action taken by doctors in state health we are all aware of the absolutely pathetic remuneration they receive.

Neither private nor public doctors are the ones draining the funds from excessive earnings. Inefficiencies in both systems are hampering good medical care. Those who control our tax money will use it better if they experience the consequences of inadequately funded health care.

I will feel confident that we are on the right road when I hear that Zweli Mkhize, Zanele Hlatshwayo and Rob Haswell are attending East Street clinic for their and their family’s health needs.


• Dr Russel Kirkby has been in practice for 34 years and has worked in the public and private sector in clinical and academic medicine.

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