Wyndham Hartley, Business Day, 1st Edition, Oct 23
Trust seeks equity in access to public, private health care
Cape Town A social health insurance system designed to close the gap between private and public health care should be considered in the face of a stalled drive for equity in access to health care.
Private sector spending per person was five times more than the public sector's, Parliament's health committee heard yesterday. Antoinette Ntuli of the Health Systems Trust said less than one in five South Africans were covered by medial aid and that while 70% of whites were covered only 10% of Africans enjoyed access to medical aid.
She said in recent years there had been a decline in spending on primary health care and many provinces had fallen behind.
She also suggested to the committee that attention should be given to mechanisms that determine the spending on provincial level on health services.
Health is a shared competence between national and provincial government and health spending in the provinces comes out of their global allocation from the national treasury. The size of health spending is determined by the provinces.
Ntuli said that consideration should also be given to introducing a stronger equity-backlogs component to the formula which determined the global allocations in the provincial budgets.
She indicated that in addition to some provinces perhaps not allocating sufficient funds for health care there were also indications that SA was not getting value for money in terms of the money which it was spending on health care.
She pointed out that while Venezuela had the lowest gross domestic product (GDP) per capita, it also had the lowest mortality rate of the four for children under five years at 23 per 1000.
SA, with a per capital GDP almost a third higher, had a mortality rate for the under fives three times higher.
Ntuli said that between 199293 and 1997-98 there was growth in government spending on health care and a shift towards primary health care.
To illustrate the divide between private and public health sectors, she said that of all nurses in SA, 59% were in the public sector while of all psychologists 94% were in the private sector. Seventy-six percent of pharmacists were in the private sector, 93% of dentists, 75% of specialists and 73% of general practitioners.
This led to the recommendation that further measures to reduce the inequity between the sectors should consider a social health insurance that allows for cross subsidising between the haves and the have-nots.