South Africa poised for national health system

The South African government hopes to begin implementing its plans for a national health system that will bring free primary health care to all South Africans from 1 April. The plans will ensure that regardless of race, sex, income, or ethnicity all South Africans will have equal access to a package of benefits at public health facilities.

These benefits could include access to private general practitioners and some other health professionals, who will be contracted to the proposed district health authorities to provide care to state patients. The health ministry is now drafting legislation aimed at providing the framework within which the changes will take place. At least one draft of the proposed new law contains, for the first time, the notion that health care consumers will have a legally enforceable set of rights.

The system will function in tandem with the existing, expensive, private health care system. Among the likely changes will be an essential list of around 150 drugs available for primary health care use in the public system. A plan to control the private sector of the pharmaceutical industry, by making these cheaper drugs available to the private sector, has been put on hold for two years.

The industry has threatened higher prices to the state sector if it cannot charge the higher prices to the private sector, which it claims are necessary to survive. During the two year grace period given to the industry it will be expected to regulate itself sufficiently to ensure that the government does not impose several threatened measures.

The Department of Health, worried about understaffing in some areas, has begun moving interns at medical school into “underserved areas” and is committed to ensuring that local medical graduates cannot enter private practice without a further two years of “community service” in hospitals either in rural areas or black areas, where South African doctors currently refuse to go.

At present doctors from other countries are temporarily filling the 2000 vacancies in public hospitals. The Medical Association of South Africa is opposed to forcing doctors into community service, arguing that a system of incentives would be better.

One of the most contentious issues of the proposals is health insurance. The government is committed to health insurance for all employees, but it wants to regulate medical schemes and introduce penalties for insurers who “risk rate” their members.—PAT SIDLEY, freelance journalist, Johannesburg