Academic essay:
It is argued that health care should be founded on the needs
of South African citizens in the form of a ‘people centric’ NHI. In this ‘people
centric’ NHI, citizens willingly survey health services and enable a
transparent, efficient, accountable, management, system. In the former instance,
citizens play an active role in policing the quality of public health care
services. This essay briefly looks at why the public health system
needs to shift into a ‘people centric’ NHI. It looks at how this is possible, while
simultaneously learning from, mirroring where possible and considering ‘people centric’ private sector contributions,
on how to make ‘people centric’ work for the public system. This essay briefly explains a ‘people
centric’ public sector approach to Dr Brian Ruff's argument that we need to
deliver good quality services to more people using the existing resources. He
suggests that South Africa spends too much on treating patients in hospitals
rather than in primary health care facilities (Dr Brian Ruff, 2013). Additionally it discusses the Witwatersrand University, Chair
of Social Security Systems, Administration and Management Studies, Professor
Alex Van den Heever’s idea of how the proposed National Health Insurance can be
made accountable by using ‘people centric’ public participation to correct health
management accountability (Alex Van den Heever 2013).
Then, Dr Jonathan Broomberg and Dr Craig Nossel from Discovery
Health Insurance share their private health care concepts and innovative
advancements in ‘people centric’ private health care that could be mirrored and
applied in the public sector
Firstly, citizen’s have lost faith in public, primary,
preventative care due to inefficient, service delivery, non existent and
unpleasant treatment therefore sick people bypass primary care to curative
hospital care. Linked to the previous
issue is that health consumer behaviour leads to the over utilisation of
resources at hospitals. However, Health minister Aaron Motsoaledi is determined
to make preventative care work. On the 15 May 2013, in the Health Budget speech
he said that, ‘[p]revention of diseases and promotion of health is going to be
the heart beat of NHI in South Africa’ (Department of Health 2013).
On the way to reform, making the NHI[1]
‘people centric’ would involve the public in the creation of primary facility
systems that sufficiently serves the healthcare needs of all (Wikipedia 2013).
In the context of a ‘people centric’ NHI, information sharing at all levels;
government, the department of health, hospitals, medical practitioners and
patient is driven by public participation. With information sharing all health
stakeholders are privy to information that can enhance policy, systems, medical
treatments and service delivery. The previous coupled with Dr. Nicola Christofides’s concepts and practices of social behavior
change[2],
could work toward building and embedding trust among community members
which could eventually spread to the larger public. The previous solution could
lead to redistribution from hospital-centric usage to primary care usage and
thus free up resources to be reallocated and used toward good quality care for
more people, using the existing resources (Dr Brian Ruff 2013).
SA’s political patronage model[3]
[4]
has been in play since the inception of the African National Congress
government[5]
in 1994.The patronage model allowed government to centralise the health system[6],
appoint all public health practitioners and increase salaries (Van den Heever
2013). In the year 2000, despite having
no qualifications for the jobs, politicians were appointed to do civil servant
jobs (Van den Heever 2013). Because the politicians were only accountable to government
and not to society. Accountability failure seeped in and degraded the’ top and
senior levels of management’ in hospitals (Van den Heever 2013). Salary increases in the public health sector
eventually ran the health budget into ‘structural deficit’ thus hospitals were
unable to pay their bills, ran out of supplies and staff, with a result ‘people
died during this period’ (Van den Heever 2013).
Professor Van den Heever says,
Part of the problem that we are
having in SA is that really, there is no sufficient public dialogue on health
systems reform and therefore a lot is just driven by special interests[7]
(Van den Heever 2013).
He continues to say that theoretically, government should be
accountable to society but they are not (Van den Heever 2013). The public needs
to get involved and start holding government accountable for lives lost.
According to Van den Heever, a systems design approach to the political
patronage model is to ‘make services below the political level accountable to the
rest of the population’ (Van den Heever 2013) He says that independent
supervisor boards[8]
would be in charge of appointing and firing the Chief Executive Office, the
Chief Financial Officer and the Chief Operation Officer of a hospital and in
this way the ‘CEO’s role is linked to performance (Van den Heever 2013).’
In addition, in an article by Anso Thom, in the Argus,
on 6 May 2013, ‘Outcry over public-sector doctors in private practice’, doctors
are shown to be milking the system by doing Remunerative Work Outside Public
service (Thom 2013). While doctors are
still registered as being on duty in the public sector, they are additionally
working in the private sector. The afore
mentioned doctors would earn approximately R 1.2 million in the public sector
plus whatever their private sector salary (Van den Heever 2013). A ‘people
centric’ NHI based on public participation would adjust systems that rectify
this kind of abuse and create a more accountable system.
Furthermore, Dr Jonathon Broomberg, from Discovery Health,
on the 29 May 2013, at the Discovery Health Head Office in Sandton, argues that
South African ‘health care looks like manufacturing in the early 20th
Century’ (Broomberg 2013). He suggests
that hospitals should specialise rather than provide all curative care[9]
(Broomberg 2013). In an article in Business Day, by Tamar Khan, on the 30 May, Specialist
Clinics are Key to Cutting Costs and Waste, she demonstrates Broomberg’s point,
that time and costs for treatment in hip replacement studies in the United
Kingdom and the U.S is drastically reduced: ‘average length of stay was halved from 7.34
days to 3.5 days, surgery was reduced from 126 minutes to 75 minutes’ (Kahn
2013). Dr Broomberg continues to say that ‘a gap exists between health
consumers and suppliers’ (Broomberg 2013). Discovery Health Insurance has
bridged the gap with ‘big data innovations’ (Broomberg 2013) and have implemented
the patient history ID which has given doctors and specialists mobile access to
patient histories.
Similarly, telemetrics have enabled practices to keep a
close watch on patients via telemetry devices. Now a diabetic can be monitored
by a doctor via a device
and be notified in case of an emergency (Broomberg 2013). Lastly,
Dr Craig Nossel, head of Vitality Wellness, says that behaviour economics is the way forward in studying
health consumers and is another example of ‘people centric’ health
innovation. Although Discovery Health contributions to a ‘people
centric’ health care model is a private initiative and seem out of reach for
the public sector, Public Private Partnerships have created space for private
investment in the public sector and empowering it to serve South African citizens.
A ‘people centric’ NHI is one solution that is implementable
without the need of financial resources. Likewise, a people centric’ NHI is the
one thing that can solve both problems of management and accountability. Public
partnership with a ‘people centric’ private sector is realistically achievable.
[1] Van den
Heever claims that there is no such thing as the NHI there is only the public
system and that the NHI is political speak (Van den Heever 2013)
[2]
Discussions at this seminar was held on how to rebrand healthy food into a
status symbol to encourage people to eat healthier and thus follow disease
prevention steps.
[3] The
patronage model will need to be done away with for the ‘people centric’ NHI
model to work. Based on how hard they have worked to keep it in, it is apparent
that the ANC will first need to be voted out before the ‘people centric’ model
will take effect.
[4] The
political patronage model in the United States of America sunk their public
system and will do the same to the SA system (Van den Heever 2013)
[5] Special
mention of the ANC and government is mentioned here to show that party politics
gets in the way of managing the health system efficiently
[6] Even
though government seems decentralised, they are not. Patronage appointments at
the top level of management are still centralised. Van den Heever says that, ‘if
the MEC appoints somebody it means they don't actually have to be accountable
to anybody. They just have to be
accountable to the political hierarchy and therefore they have a conflict of
interest with society’ (Van den Heever 2013)
[7] SA is
supposed to be a democracy but we seldom vote on things as intrinsic as whether
our public health system is going to be managed by government and maintain a
central management system or whether public bodies will lead the public health
system.
[8] These
could be made up of public members like the example of private medical scheme
boards.
[9] Alex Van
den Heever says that ‘a hospital is actually a complex service and its not
being treated as one’ (Van den Heever 2013) supports Broomberg’s statement that hospitals
should specialise to save time and money (Broomberg 2013).
Bibliography
Alex van den Heever. 2013. Everything you ever wanted to know about the NHI. Retrieved on 10 June 2013 from Audio Clip
Discovery Media Summit. 2013. SA Private Healthcare 3.0. Retrieved on 10 June 2013 from Audio clip
Dr Christofides, Nicola. 2013. What is new in Public Health? Retrieved on 10 June 2013 from Audio clip
The Department of Health. 2013. Health Budget speech by Dr Aaron Motsoaledi, MP, Minister of Health, National Assembly. Retrieved on 10 June 2013 from http://www.doh.gov.za/show.php?id=4240
Tamar Kahn. 2013. Specialist Clinics are Key to Cutting Costs and Waste. Business Day Live. 2013. Retrieved on 31 May & 11 June 2013 from http://www.bdlive.co.za/business/healthcare/2013/05/30/specialist-clinics-are-key-to-cutting-costs-waste
Thom, Anso. 2013. Outcry over public sector doctors in private practice. The Argus. 6 May 2013
Wikipedia. 2013. Patient Centred Care. Retrieved on 10 June 2013 from http://en.wikipedia.org/wiki/Patient-centered_careFollow me @HarkerMegan on Twitter
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