Bill aims for rational and fair allocation

Manto Tshabalala-Msimang

This week, the National Health Bill has been the focus of public hearings by the Parliamentary Portfolio Committee on Health.

Individual sections of the law were placed under the microscope to establish precisely what they mean.

Of course, this is a valuable process. But as we took the bill apart, bit-by-bit, I invited participants to consider the measure as a whole. Why do we have a National Health Bill?

We believe the fundamental purpose of the bill is to design a health system suited to the enormous task of ensuring all people in our country have access to healthcare. For government, this is not just a noble ideal.

It is a real responsibility in terms of the bill of rights in the constitution. Moreover, we have a duty, over time, to increase the scope of services within the bounds of available resources.

The National Health Bill tackles this challenge from a number of different angles.

Very importantly, it assembles the pieces of the public health system in a coherent way and clearly defines what health functions each sphere of government perform.

Our experience over the last nine years has informed this aspect of the legislation.

It also makes sure the links between the various spheres of government are firmly in place, so that there is no excuse for poor co-ordination at policy level. The informal structures of consultation that we developed as a way of expressing co-operative governance are now cast firmly in legal language.

Central to any rights culture - especially when it comes to socio-economic rights - is the consumer. And the bill deals with the rights of patients as individuals - focusing on patients' rights to information, to confidentiality, and to choices in terms of the health interventions they will undergo. It also deals with their collective rights to participate in policy making.

Perhaps the most striking feature of the bill is that it defines private and public healthcare providers as part of a single national health system. When it talks about the rights of service users, the ethics of medical research and compliance with basic standards of care, this legislation draws no distinction between the public and private sectors. The degree to which government exercises control over the private healthcare sector is always a sensitive issue.

In discussions on the National Health Bill, debate tends to focus on the provision that all health establishments will be licensed on the basis of need for their service.

In the past, some of the loudest critics of this provision were precisely those who cry foul when medical aid rates shoot up, leaving pensioners and those with low incomes out in the cold. Or who decry the inability of the public health services to ventilate all low-weight babies, to provide kidney dialysis for all in need and to offer expensive drug treatments.

You can't have it both ways. The market alone is not a fair or effective mechanism to distribute healthcare. Resources simply do not follow demand. 

If they did, we would not have 75% of our people depending on public facilities, while this sector consumes about 47% of national health spending. We would also not have the vast majority of doctors and medical specialists devoting themselves to the private sector.

As government, therefore, we examined the existing relationship between the private and public health sectors - and how this impedes universal access to good healthcare.

It is clear that inefficiencies and inflated costs in the private health sector not only hurt private consumers, they also turn the screws on the public sector.

All health facilities draw their professional personnel from a limited common pool. If private hospitals proliferate in a situation where half their beds stand empty, they absorb professionals without providing value-for-money care. In this context, inflated prices and unethical practices, such as over-servicing, are likely to arise. Faced with unreasonable costs, many patients resort to the over-stretched public sector.

And so the vicious cycle will continue ... unless someone stops it.

Through the National Health Bill, and specifically through needs-based certification of health establishments, government seeks to establish a more rational and fair allocation of health resources. This is the key to good healthcare for all.

Perhaps I am an optimist, but I believe debate on the certificate of need did not question its legitimacy but sought to improve the process. I believe that South Africans realise that we have to rise above our narrow interests to build a united nation.

I also believe that we appreciate that effective healthcare reduces the inequalities and tensions in our society and enables us to look each other in the eye. Dr Tshabalala-Msimang is the Minister of Health. ( Source: The Cape Times, 20 August 2003).