HEALTH CHARTER

HEALTH CHARTER

Presentation to the Portfolio Committee August 2005

Access to health care services

Equity in health care

Quality of health care

Broad Based Black Economic Empowerment

HEALTH CHARTER AREAS OF TRANSFORMATION

Access to Health Services

• Inadequate access to health services due to:– Geographical– Financial– Physical– Communication– Sociological

Access to Health Services

• Access to medical schemes is diminishing

• Inequitable application of resources results in inadequate access

• Providing health services at low cost

• Geographical inequities skewed towards urban and private sector

Number of Medical Scheme Beneficiaries 1974 - 2003

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

19

74

19

75

19

76

19

77

19

78

19

79

19

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

Num

ber

of b

enef

icia

ries.

Registered Schemes Exempt / Bargaining Council Schemes

Number of Beneficiaries of Registered Medical Schemes 2000-2004

6730 6764 6714 6672 6668

27172688265226272599

4131 4137 4061 39513984

0

1000

2000

3000

4000

5000

6000

7000

8000

2000 2001 2002 2003 2004

Th

ou

san

ds

MembersDependantsBeneficiaries

Equity in Health Services

• Equal access to equal care for equal need in which resources are efficiently utilised in a fair manner

• Inefficient and inequitable distribution of resources between public and private sector relative to population served

• Inequity between provinces


• Private sector membership becoming unaffordable

• Membership has decreased

• Rapid increases in private hospital expenditure

• Increase in non-health expenditure

• Out of pocket payments


SA - Health System 2002/2003

Public sector

R33.2 billion

Private sector

R43 billion

Serves 6.9 m

Pcap = R6231.88

R519.32 pmpb

Serves 37.9 m

Pcap = R875.98

R72.99 pm pp

Growth in Scheme Expenditure on Private Hospitals, 1997-2003

• In real terms, between 1997 and 2003:

– total private hospital benefits grew by 65.8%

– ward fees grew by 45.2%

– medicine benefits increased by 84.0%

– consumables increased by 74.0%

– theatre fees increased by 94.3%

Proportions of Benefits Paid by Medical Schemes in 1990

Total Private Hospitals22.9%

Specialists, Allied and Support16.0%

Total Public Hospitals5.5%Medicines out of

Hospital23.2%

GPs, Primary Care and Dental25.0%

Other7.5%

Proportions of Benefits Paid by Medical Schemes in 2003

Total Private Hospitals33.8%

Specialists, Allied and Support26.6%

Total Public Hospitals0.6%

Medicines out of Hospital22.3%

GPs, Primary Care and Dental14.0%

Other2.6%

Benefits Paid on Hospitals in Real Terms (2003 Rands), 1990 to 2003

0

1

2

3

4

5

6

7

8

9

10

11

12

13

141990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Billio

ns

Calendar Year

Ben

efi

ts p

aid

by M

ed

ical S

ch

em

es (

2003 R

an

d t

erm

s).

Private Hospitals

Public Hospitals

Quality of Health Services

• Low cost options should not be low quality options

• Current business models

• Sustainability: Elimination of inefficiencies, duplication of resources, cost ineffectiveness

• Price competition

Broad Based Black Economic Empowerment

• Levels of ownership

• Equity in ownership

• Procurement

• Employment Equity

• Corporate social investment

• PPIs

Way Forward

• In the Charter document the parties make various resolutions and put forward solutions in respect of each key area

• The document is released to the broader stakeholder body for comments and inputs.

• View constructively, and if you don’t agree put forward alternatives

Proposed Solutions & Resolutions

ACCESS• Investigating the feasibility of the creation of a

category of independent practitioners to be contracted to the state in order to improve access to health care at the primary level;

• Appropriately increasing the range of health

services available to under serviced communities using solutions tailored to meet the needs of the particular community;


ACCESS• Provision of information to address the particular

needs of vulnerable groups, including people living in rural and under serviced areas and the illiterate;

• Public private initiatives to more efficiently utilise available resources, reduce inequities and improve access to provision & financing of health services;


ACCESS• Providing or sponsoring health profession

education, training and development which includes - – Formal health training and education;– Continuing Professional Development education,

sponsored programmes and events in relevant categories of health care personnel;

– Management & Leadership programme provision or sponsorship;


ACCESS• Using existing funding mechanisms such as the

skills development levy to more efficiently and effectively provide financial support to students who wish to study in the health field.

• Sector marketing and career education campaign• Attracting home qualified South Africans


EQUITY• Developing a minimum defined basic

package of care that is available to all patients in both the public and the private sectors

• The elimination of inefficiencies from health service delivery;

• Zero tolerance of unfair discrimination


EQUITY• Setting annual targets for recruiting, training and

retention of health care personnel; • Setting out milestone leadership programmes with

curricula that meet the needs of health organisations;

• Developing a code of practice on the ethical recruitment of health professionals;


• Putting in place programmes that result in the broader representation of black persons in the workplace.

• It is the target at all levels in the chain that by 2010 the workplace will be 60% black across the value chain and will comprise 50% women.

• Also it is a target that by 2014 the workplace will be 70% black across the value chain and shall comprise 60% women.


QUALITY• The implementation of benchmarked quality

assurance programmes that include the measurement of health outcomes

• The consideration of complaints by users and the use of such complaints to inform the planning and delivery of health services so as to be able to continually improve the quality of health care


QUALITY• Development of low cost health service and

financing options accessible to low and middle income groups and that assure value for money in terms of health outcomes;

• Conducting regular and sustained training programmes for health care personnel on the rights of patients and the Batho Pele principles;


BBBEE• Each of the firms or businesses in the healthcare

sector shall be at least 26% owned and/or controlled by or black people. This process should commence immediately.

• Further, by 2010 at least each of the firms or businesses in the healthcare sector shall be 35% owned and/or controlled by black people.

• Equity ownership by black people shall increase to 51% by 2014.


• Procurement policies favourable to firms owned or controlled by black people will be implemented. Stakeholders commit to supporting government on these initiatives especially in the areas of:– hospitality services and general procurement– pharmaceutical products and medicines– medical equipment– professional services– IT systems – distribution and wholesaling services


BBBEE• At least 60% of all procurement shall be from

black owned firms or black persons by 2010. By 2014 this should increase to 80%.

• Private sector expenditure on social responsibility

projects providing funding and resources for new and existing community development projects.


• Development finance must be derived from three sources, partially from DFIs, particularly where the risk profile excludes other sources, with the majority sourced from mainstream financial institutions and vendors themselves.

• There must be a concerted effort from both public and private sector to approach parastatal funding institutions to come up with ways of funding BBBEE transactions in the health sector as it is not affordable for current banking institutions to fund such transactions.

Implementation

• Implementation a process: Flexible to allow for changes and adjustments

• Mechanism must be developed to monitor

• Health Charter Committee under National Consultative Health Forum

• Proposals put forward to enable health sector to go beyond other charters

Thank you

Documents

HEALTH CHARTER