Health care system

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

This indicator measures the average cost of a patient visit to a primary care facility. In practice it is the average cost to the health service of a patient visit to a community health centre, clinic, satellite clinic or mobile clinic (but excluding district hospitals) - and which average cost includes the cost of managing the district¹.

This indicator measures how the resources available to the hospital are being spent and is a marker of the efficiency of the hospital as a whole. It is a composite process indicator in that it links financial data with service-related data from the hospital admissions and outpatients.

The indicator measures the average cost per patient, per day, seen at a district hospital, and is expressed as Rands per patient day equivalent. The indicator value is calculated by dividing the total expenditure¹ of the hospital by the patient day equivalent (PDE)².

The proportion of total district expenditure for management activities during the 2008/09 financial year, including the management of district hospitals, was 5.6%. This proportion is the highest over the past four years the lowest being 4.7% in 2006/07.

Figure 1, Percentage of district health services expenditure on management, by district, 2008/09, shows the variation in the proportion of total expenditure on management² country-wide.