Download Transforming health care - Treatment Action Campaign

National Health Insurance
Input to the TAC
COSATU
Need to restructure health
system
Poor outputs despite high spending by
international standards
Rapidly rising cost of medical aids
Growth in private sector care leading to
deeper inequalities and resentment
Government proposals
Problems in health caused by underfunding:
Inadequate contributions by those who could pay
more
“Dumping”
Solution:
All formal workers must join medical aids
Government may establish a low-cost medical aid
to help out
Regulation of private providers to ensure
efficiency
Concerns
Agree on need to regulate private costs
But basic premise of underfunding is wrong –
Therefore unaffordable for the economy and individual
workers
Need to equalise funding, not increase it overall
Does not address problems other than funding
Management
Skills development
Conditions and career paths
Privatisation of health seems unconstitutional
Concerns
Focus on tertiary – but most workers
want improvements in primary
Virtually complete failure to include
consumers – either employers or
workers – in consultation, despite TOR
Health indicators 1995-2001
South
Africa
Inputs
% of GDP
expenditure p.c. in US
dollars
private healthcare as
% of total
physicians per 1000
Outcomes
% of one-year-old
children immunised
against DPT
infant mortality rate
survival to age 65 women
survival to age 65 men
HIV prevalence
TB prevalence
country groups:
middle
low
high
income income
income
Brazil
Cuba
Mauritius
Tan zania
8.8%
5.9%
4.3%
10.2%
8.3%
6.8%
3.4%
5.9%
255
116
21
2736
267
169
134
12
58%
48%
73%
38%
59%
11%
44%
53%
0.6
1.9
b
3.0
1.3
5.3
0.9
81%
85%
61%
94%
97%
99%
92%
85%
56
31
80
5
31
7
17
104
33%
78%
60%
90%
79%
88%
85%
31%
27%
68%
55%
80%
62%
81%
70%
27%
20%
526
1%
107
2%
233
0%
18
1%
68
0%
14
0%
69
8%
359
0.5
0.0
a. Figures for various years between 1995 and 2001. b. 1980. c. under 0,05.Source: World
Bank. 2003. World Development Indicators 2003. Washington, D.C. USA.
b
Cost to workers
Minimum required benefits estimated at
R200 per person per month, or around R800
to R1000 a family
Even if workers only paid a fraction, would
still be hugely expensive for many
Contradiction between proposed incomebased subsidy and requirement that take on
more risks, especially as cost of minimum
benefits are heavily related to age
For example: public service
Punted as standard bearer for SHI
Minimum employee contribution of
R220/month, so employer contributes R440
20% of public servants earn around
R2500/month
Therefore increase in the cost of employment
by 25%
Given unemployment of 31%, this is
ludicrous
Underfunding the public sector
Effective cut in 1994, just when had to
extend to whole population and respond
to HIV
Small but steady fall as percentage of
total budget
Result: drive people into the private
sector – where costs have soared
The health budget
32,000
12.5%
% of total
31,000
12.0%
30,000
Real amount (bns)
11.5%
29,000
28,000
11.0%
27,000
10.5%
26,000
25,000
10.0%
1998/9
1999/2000
2000/1
2001/2
2002/3
2003/4
Principles for solution
Basic healthcare, including primary care, must be
accessible for all
That means private care must remain an optional
extra, NOT cradle-to-grave
Must ensure reasonable budgets for public health –
cannot ignore underfunding
Must control private costs and ensure do not drain
public sector
Strengthen non-profit provision, which includes
community, employment and union based
COSATU’s understanding of NHI
Mix of public and private providers –
but regulate to avoid duplication
For covered conditions, single source
of payment through non-profit fund
Progressive levy with cross
subsidisation plus general taxation
Should not increase cost to those
earning under R10 000
Contrast SHI and NHI
SHI
Increase medical-scheme
funding
Mixed providers
Regulate private providers
Does not directly increase
public funding
Much higher overall cost
Does not remedy publicservice management and
HR problems
NHI
Single funding source through
the state
Same
Same – using control of funding
Ensure public sector has
greater share in total
No increase in overall cost
Same, although improved
funding should help