Aaron Motsoaledi

HEALTH Minister Aaron Motsoaledi yesterday revealed a proposal to introduce three levels of healthcare in SA, with a focus on underserved areas such as rural regions and schools.

The proposal came at the Board of Healthcare Funders’ annual conference, where Dr Motsoaledi called for the regulation of healthcare fees .

He said manufacturers of antiretrovirals (ARVs) originally told the government it was not possible to reduce the cost of the life-saving HIV/AIDS medication because it was expensive. "We said: ‘ Give us the costs .’ And when the costs were given, we found that ... it was not as expensive as that," Dr Motsoaledi said. "And you remember we reduced ARV ( prices ) by 50%, didn’t we?"

Dr Motsoaledi elicited a swift response from the private healthcare industry last week after he broke down the cost of a circumcision in a private hospital.

According to a presentation by Dr Motsoaledi , hospital fees alone ranged between R4184 and R13900, excluding urologist and anaesthetist fees. These hospital fees did not include an overnight stay. In contrast, one of the urologists could do the procedure for R1500 in his rooms, and general practitioners in townships charged R600-R1200.

After a similar presentation last week, private healthcare providers said state hospitals charged less as they were subsided by taxpayers.

Whether medical schemes have to pay in full the minimum prescribed benefits or not to their clients is the subject of a court appeal.

During his presentation yesterday, Dr Mostoaledi hit out at the "deadly divide" in SA’s healthcare system . He announced a plan to introduce three streams of care, which would have an increased effect in rural areas.

The first is the provision of specialists in each of the rural district municipalities. These positions would be announced by the end of this month, and if the posts were not filled, the minister had received an undertaking from all the medical schools in the country to fill the posts from among their own staff on a year-long rotational basis.

The second part of the plan was the establishment of a school health programme. "We have 12-million learners and no one taking care of their eyesight and hearing. Drugs and teen pregnancies are running rampant, while we wait for them at the hospital. I want to see nurses in every school, and we will call on the help of retired nurses if necessary."

The third facet of the proposal was the provision of primary healthcare workers in every municipality. The success of a pilot project in KwaZulu- Natal has led to plans to roll out the system in every municipality in the country. With Sapa

Private healthcare prices in South Africa have to be regulated, Health Minister Aaron Motsoaledi said.

Speaking at the Board of Healthcare Funders conference at Sun City, Motsoaledi called for a pricing negotiation forum, saying healthcare in South Africa was "predatory".

He said the health structure was worse now than during apartheid.

"There is a tendency to believe that a long and healthy life is the right of those that can afford it and that is totally wrong," he said.

"The reality is that our people are dying in large numbers. We are running a healthcare system in this country that is not working."

The solution lay in re-engineering the primary healthcare system.

Motsoaledi announced a plan to introduce three streams of care, which would have a particular impact in rural areas.

Board spokesman Heidi Kruger welcomed Motsoaledi's comments, saying: "I think it's brilliant. The sooner it comes through the better. We can't have a situation where there is no containment on costs."

Kruger said private healthcare providers charged whatever they wanted, "pushing up" medical aid premiums.

The current system was an "open-ended liability for funders" so medical schemes could not budget properly.

Regulating healthcare costs would be "very constructive" and "provide certainty", Kruger said.

Motsoaledi is hoping to begin setting up the pricing forum by the end of the year.

However, he told delegates at the conference that hospitals were creating a stumbling block in the process because that sector did not want to have its prices regulated.

Motsoaledi accused the public and private health sectors of "engaging in destructive, unsustainable practices". He was particularly outspoken about the high cost of private hospital treatment and called for a stronger emphasis on primary care, rather than the present curative system with its "rapidly escalating" costs.

"The public health system is in a crisis of quality and I am going to deal with it head on, but it is not an excuse for profiteering," he said.

"Our country is going in the wrong direction . all of us, public and private," he said. "We have a predatory healthcare system where the sick and the vulnerable are the ones who get attacked."