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Health Systems. Republic of South Africa. South Africa in Relation to Africa. The RSA occupies the southern most part of the African Continent, with a surface area of 1,220km². Population of +46 Million people. Growth rate Inflation National debt Unemployment GDP Exports Imports. - PowerPoint PPT Presentation
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South Africa in Relation to AfricaThe RSA occupies the southern most part of the African Continent, with a surface area of 1,220km². Population of +46 Million people.
Understanding South Africa
Growth rate
Inflation
National debt
Unemployment
GDP
Exports
Imports
3.6 - 4%
4-6%
37% of GDP
30-40%
$472 billion
45.2billion
32.6 billion
• Powerhouse of Africa• GDP is 25% of the GDP of Africa• Leader in Industrial output (40% of
Africa's output)• Generates half of Africa’s electricity
• Bustling informal economy– Unmeasured– Unregulated– Untapped potential
Source:,www.sainfo.com
• Natural minerals & metals
• Growing manufacturing sector
• Strong service industry
• Growing potential tourism industry
• Magnificent natural beauty
45%
25%
30%
service
industry
agriculture
Source:,www.sainfo.com
Major
metropolita
n
areas
Provincial structures
at regional
level
9 provinces
Cape Town
Port Elizabeth
Durban
Johannesburg34% GDP34% GDP
Health Authorities
•Public EntitiesNational Department of Health
Provincial Health Department
Primary Health/Community Health
•Private EntitiesPrivate hospital groups and clinics
Specialists
Nurses
Pharmacists
Allied Health Workers
Other Influential Role Players
•Statutory Bodies (HPCSA; MCC)
•NGO/Donor agencies
– involved in a range of health promotion and prevention projects
•Lobby groups/Unions (TAC; COSATU)
•Defense special health care facilities
•Mines special health care facilities
Process Flow for an insured Individual
LOW RISK Health individuals
Apathetic &
Nostalgic 65%
Diseased 20% AV
E. W
OR
KF
OR
CE
C
ON
TIN
UU
M
HIGH RISK
HEALTH SERVICES CONSUMPTION OF EMPLOYEES NOT IN MEDICAL SCHEME *
* Large number will become covered with advent of SHI
State Clinics
Dentists
Pharmacies
Optometrists
State Hospitals (specialists)
GPS/Dispensing Doctors
HIV/AIDS Program
Represents health risk management value chain – covered by scheme system
Represents Employer-based health risk interventions for all or some employees
Represents health risk management value chain for MB/Basic benefits– uncovered outside scheme system
Real T
ime
Inte
rfacin
g
•MC Program info
•Claims info
•Benefit Info
•PMB Protocols
Specialist Network
HIV/AIDS Program
Choice of Service provider -Health Incentives/rewards
RISK ID
Hospital Benefit mgt
Disease Management
ADMIN & MC SYSTEM
GP Network
Pharmacy Network
Oncology
Medicine Mgt
PMB Mgmt
Maternity
Hospital Network
Optometrist Network
Dentist Network
HEALTH RISK MANAGEMENT FOR %
OF WORKFORCE IN MEDICAL SCHEME
EMPLOYER LEVEL INTERVENTIONS TO MANAGE HEALTH RISK WHICH MAY APPLY TO COVEREDS AND UN-COVEREDS
WorkplaceClinics OCC
Health
EAP AbsenteeismManagement
Education Executive Health
Process flow for an un-insured individual
No risk assessment
Available Choices ofService Provider
Public Primary Health Care facility
Will fully fund any Drugs from the Pharmacy
Referral to a Provincial or Tertiary Public establishment
Traditional Healer
Herbal Medicine
Traditional Networks and Referral system within the
Community
Unwell individual
PoorFinancially Affording
Will pay cash for Private Health Care facilities
Healthcare Costs
The inter-related challenges impacting on healthcare costs and affordability
Employers moving away from post-Retirement financing – need for pensioners to self-manage
Lack of adequete outcomes reporting to show the value add of MHC (PMB/DRM)
Growing concern amongst employers as to whether tools used to control costs to date (managed care, benefit design/re-structure) are working to extent it was hoped
Cost-shiftingfrom employer to employee
Provision of low cost healthcaredelivery to enableaffordable productsand access for emergingmarket
Move to Social Health Insurance – more employees on scheme benefits and greater employer subsidy
4.82 Million people living with Aids
Prevalence rate of 26.5%
7 million
37 million
Population covered: Private vs. Public
Private sector
Public sector
Health Care ExpenditureHealth Care Expenditure
7 million
37 million
Relative expenditure split
Private sector
Public sector
R 59 billion / 58%
R 43 billion / 42%
Health Care ExpenditureHealth Care Expenditure
“Chronic inefficiency of distribution”
Wellness of the nationWellness of the nation
• WHO rates South African Health care delivery as 175 out of 191 nations
Key factors affecting health outcomes
• WHO rates South African Health care delivery as 175 out of 191 nations
• Key factors affecting health outcomes– Violence
Total deaths PA in 100 000 lives
RSA USA
89
9
Wellness of the nationWellness of the nation
• WHO rates South African Health care delivery as 175 out of 191 nations
• Key factors affecting health outcomes– Violence– Socio-economic circumstances
• Poverty
Infectious diseases
• Tuberculosis
• HIV and Aids
• Malaria
• STD’s
Percentage TB cases that are HIV positive
25%
Wellness of the nationWellness of the nation
• WHO rates South African Health care delivery as 175 out of 191 nations
• Key factors affecting health outcomes– Violence– Socio-economic circumstances
• Poverty
• Lifestyle
Chronic diseases
• Diabetes• Asthma/COPD • Cardiovascular (CVD)• Obesity• Metabolic syndrome
Wellness of the nationWellness of the nation
Medical Scheme Benefits -Medical Scheme Benefits -
• Prescribed Minimum Benefits – over 250 conditions
• Chronic disease cover– Covers 25 most common Chronic
Conditions– Also covers HIV/AIDS
• Other benefits– Dentistry– Optical– Out of hospital radiology and pathology
Challenges for Private SectorChallenges for Private Sector
• Cost escalation• Consumer resistance• Low growth of formal
employment• Legislative environment• Accessibility• Affordability
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