Date: 19/02/2004
Source: Department of Health
Title: M Tshabalala-Msimang: Fair Treatment Seminar
SPEECH BY THE MINISTER OF HEALTH, DR ME TSHABALALA-MSIMANG, AT THE FAIR TREATMENT SEMINAR HOSTED BY THE COUNCIL FOR MEDICAL SCHEMES, 19 February 2004
"Fairness in the context of health system reform"
Deputy Chairperson and members of the Council for Medical Schemes
Registrar of Medical Schemes
Distinguished Guests
Ladies and Gentlemen.
It gives me great pleasure today to open this groundbreaking and seminal event.
I refer to it as groundbreaking because I am unaware of any other regulatory sector in this country, which has embarked on such detailed and focused work on the sources and solutions to unfairness experienced by consumers.
I think it is seminal because I have every expectation that the interactions between regulators, industry and consumers in this forum will generate far-reaching ideas and proposals which will shape a future medical schemes environment which is more tuned toward better meeting the needs of consumers.
Having had the opportunity to peruse the draft report which forms the basis for this seminar, I am most impressed by the quality of the input and the amount of thought and work which has gone into its production. And I have no doubt that the finalization of this report, following input from consumers and other stakeholders in the course of the next two days, will result in a vital blueprint for action both by government and civil society.
This seminar focuses on fair treatment of medical scheme beneficiaries, and I am aware that my address will be followed by an address by the Registrar conceptualising this work within the aims and objectives of the Medical Schemes Act, and the regulatory mandate of the Council for Medical Schemes.
However, it is important at the outset to conceptualise this conference within government's broader vision for reform of the health system, of which protection of medical scheme beneficiaries is a part, albeit an important one.
Indeed, the concepts of fairness and equity are at the heart of the vision of the current government of South Africa. Since 1994, government direction has been determined by the principle that South Africa belongs to all who live in it and that every citizen deserves access to essential health care.
In the context of health system reform, issues of fairness are intrinsically linked, indeed often synonymous with, issues of equity in the distribution of health care resources. Achieving equity in the distribution of scarce resources is a primary goal of all health systems internationally. In South Africa, it is more so than most.
While I do not wish to dwell on the past, the history of apartheid in South Africa left a legacy of inequities and distortions in resource allocation which have been difficult to overcome. When the African National Congress came into power in 1994, the new government inherited a fragmented, racially-based, hospital-centred health system. The system benefited the white minority and the rich whilst neglecting the poor, and those in townships and rural areas. Children died from preventable illnesses linked to poverty, poor nutrition and lack of sanitation.
On the other hand, a sophisticated and expensive private health sector consumed over 60% of total health care expenditure while providing care for less than 20% of the population. Largely due to the perverse inequities between public and private sectors, the World Health Organisation ranked South Africa 175th out of 191 countries in terms of health systems performance.
Against this background, during the past decade great strides have been made toward ensuring fairer distribution of resources and to ensuring that the intrinsic health needs of individuals are met.
This government has created a unified, deracialised national health system, with functions decentralized to provincial and district level.
Huge progress has been made to ensuring health care for all through policies and infrastructure for the delivery of primary care services. Since 1994, 900 new clinics have been built or substantially upgraded, mainly in rural areas. Free health care was introduced for children and pregnant women, and this was extended last year to persons with disabilities. In 1996, free health care at primary care level was extended to all.
Developments at primary care level have not taken place at the expense of hospital development and other disease programmes.
Through our hospital revitalization programme, we have dedicated and continue to allocate large scale resources to making hospital care more accessible to the population, and so to ensure an effective referral network. This has included large investment in capital works and the construction of three new academic hospitals to replace obsolete facilities.
Programmes for disease control and prevention have been expanded and new programmes initiated.
This has included commitment of enormous resources to a national strategy on HIV and AIDS over the past few years, which has now been supplemented by the Comprehensive Plan for Management, Care and Treatment of HIV and AIDS adopted by Cabinet in November last year.
The child immunization programme has been significantly expanded, efforts to combat escalation in malaria have intensified, and a very successful community-based treatment programme for tuberculosis was implemented.
In addition, substantial policies and initiatives have been put in place to promote more equitable distribution of resources geographically. These have included: the successful implementation of community service programmes for young health care professionals; the initiation this year of a unique system of allowances for health professionals in rural areas and professionals with skills in short supply; and the inclusion of the certificate of need provisions in the National Health Bill.
Realising that financial obstacles are themselves a significant barrier to equitable access to health care, initiatives are constantly being explored to contain spiralling medical costs. The amendments to the Medicines and Related Substances Control Act, and the draft regulations relating to a transparent pricing system for medicines and scheduled substances, are specifically intended to activate mechanisms to increase access to essential medicines. It is anticipated that consumers stand to benefit by between a 40% and a 70% reduction in the cost of medicines when these regulations become fully operational.
And in terrain in which the majority of you are probably most familiar, reforms introduced by the Medical Schemes Act were put in place to ensure that individuals burdened by disease were not unfairly discriminated against. These included requirements of open enrolment, community rating and prescribed minimum benefits, as well as recent innovations such as the inclusion of a chronic disease list in the PMBs.
While significant achievements have been made to ensuring greater fairness and equity in the allocation of health care resources, I will be the first to attest to the fact that huge challenges still remain. Some of these challenges are unique to South Africa; many are challenges experienced globally.
Huge imbalances remain in resources between public and private sectors, and between urban and rural areas, and there are still unacceptable levels of variation between provinces on expenditure on primary care. Attempts to address those inequities are complicated by competing social demands and growing needs in some areas. Significant cost escalation continues in the private sector and there are still inequities and unfairness at a structural level within the medical schemes environment.
As a government, we are committed to addressing these challenges through a variety of measures, including improved planning and allocation of resources. Health facility revitalisation will continue to be accelerated. The hospital revitalisation process will use R911 million in 2004, as part of a total budget of about R2 billion for improving health service infrastructure.
On the budget front, we are committed to: ensuring an appropriate level of funding for the health sector; creating partnerships with the private health care sector; achieving greater equity in the allocation of health resources between and within provinces; and ensuring that primary health care gets an appropriate slice of the health cake.
And very importantly, we are committed to accelerating the process of implementing a social health insurance system in this country to ensure a far greater degree of equity in allocation of health care resources at a national level. A recent Cabinet lekgotla directed the Department of Health and Treasury to finalise recommendations on Social Health Insurance by the end of March.
Our objectives of moving toward a Social Health Insurance system include the following:
* to improve access of lower income groups to quality health care;
* to reduce inequities in health care financing by improving income and risk-related cross subsidies;
* to strengthen the public health system by increasing the revenue available to it; and
* to obtain prepaid contributions from those who are able to pay for health care.
Our current thinking on the Social Health Insurance is that it will be based on three primary tenets: mandatory health insurance cover for specified groups; income-related cross-subsidies among contributors; and risk-related cross-subsidies among contributors.
A key process toward meeting these objectives has been the work, which is taking place around implementation of a risk equalization fund in South Africa. Substantial progress has been made toward this with the recent task teams on risk equalization methodologies and related tax subsidy reform proposals, and the convening of an international panel of experts to review the proposals. Substantive proposals in this regard will serve on Cabinet in the near future.
There can be no doubt then of the commitment of government to continue to ensure fair and equitable access to health services by all South Africa's peoples, through policy, legislation, funding and partnerships with a range of stakeholders.
While all this is going on at a broad structural level, I am acutely aware that our efforts can be frustrated at grassroots level by poor customer service, discriminatory attitudes and unfairness perpetrated against individuals seeking access to care.
Those factors are far more difficult to address at a broad structural or policy level, and that is precisely where a conference such as this assumes so much importance. It creates opportunities to translate the overall vision of government for fairness and equity in health care into a tangible difference for consumers at the level of individual health care transactions.
So for this reason I would again like to express my appreciation to the Council for Medical Schemes, and indeed to everyone who is attending this conference, for your commitment to ensuring greater fairness and equity in health service delivery in South Africa.
I wish you well on your deliberations over the next two days, and very much look forward to receiving a copy of the final fair treatment report, incorporating the input and recommendations emanating from this seminar.
I thank you.
Issued by: Department of Health
19 February 2004
Source: Department of Health (http://www.doh.gov.za)
Source: Department of Health
Title: M Tshabalala-Msimang: Fair Treatment Seminar
SPEECH BY THE MINISTER OF HEALTH, DR ME TSHABALALA-MSIMANG, AT THE FAIR TREATMENT SEMINAR HOSTED BY THE COUNCIL FOR MEDICAL SCHEMES, 19 February 2004
"Fairness in the context of health system reform"
Deputy Chairperson and members of the Council for Medical Schemes
Registrar of Medical Schemes
Distinguished Guests
Ladies and Gentlemen.
It gives me great pleasure today to open this groundbreaking and seminal event.
I refer to it as groundbreaking because I am unaware of any other regulatory sector in this country, which has embarked on such detailed and focused work on the sources and solutions to unfairness experienced by consumers.
I think it is seminal because I have every expectation that the interactions between regulators, industry and consumers in this forum will generate far-reaching ideas and proposals which will shape a future medical schemes environment which is more tuned toward better meeting the needs of consumers.
Having had the opportunity to peruse the draft report which forms the basis for this seminar, I am most impressed by the quality of the input and the amount of thought and work which has gone into its production. And I have no doubt that the finalization of this report, following input from consumers and other stakeholders in the course of the next two days, will result in a vital blueprint for action both by government and civil society.
This seminar focuses on fair treatment of medical scheme beneficiaries, and I am aware that my address will be followed by an address by the Registrar conceptualising this work within the aims and objectives of the Medical Schemes Act, and the regulatory mandate of the Council for Medical Schemes.
However, it is important at the outset to conceptualise this conference within government's broader vision for reform of the health system, of which protection of medical scheme beneficiaries is a part, albeit an important one.
Indeed, the concepts of fairness and equity are at the heart of the vision of the current government of South Africa. Since 1994, government direction has been determined by the principle that South Africa belongs to all who live in it and that every citizen deserves access to essential health care.
In the context of health system reform, issues of fairness are intrinsically linked, indeed often synonymous with, issues of equity in the distribution of health care resources. Achieving equity in the distribution of scarce resources is a primary goal of all health systems internationally. In South Africa, it is more so than most.
While I do not wish to dwell on the past, the history of apartheid in South Africa left a legacy of inequities and distortions in resource allocation which have been difficult to overcome. When the African National Congress came into power in 1994, the new government inherited a fragmented, racially-based, hospital-centred health system. The system benefited the white minority and the rich whilst neglecting the poor, and those in townships and rural areas. Children died from preventable illnesses linked to poverty, poor nutrition and lack of sanitation.
On the other hand, a sophisticated and expensive private health sector consumed over 60% of total health care expenditure while providing care for less than 20% of the population. Largely due to the perverse inequities between public and private sectors, the World Health Organisation ranked South Africa 175th out of 191 countries in terms of health systems performance.
Against this background, during the past decade great strides have been made toward ensuring fairer distribution of resources and to ensuring that the intrinsic health needs of individuals are met.
This government has created a unified, deracialised national health system, with functions decentralized to provincial and district level.
Huge progress has been made to ensuring health care for all through policies and infrastructure for the delivery of primary care services. Since 1994, 900 new clinics have been built or substantially upgraded, mainly in rural areas. Free health care was introduced for children and pregnant women, and this was extended last year to persons with disabilities. In 1996, free health care at primary care level was extended to all.
Developments at primary care level have not taken place at the expense of hospital development and other disease programmes.
Through our hospital revitalization programme, we have dedicated and continue to allocate large scale resources to making hospital care more accessible to the population, and so to ensure an effective referral network. This has included large investment in capital works and the construction of three new academic hospitals to replace obsolete facilities.
Programmes for disease control and prevention have been expanded and new programmes initiated.
This has included commitment of enormous resources to a national strategy on HIV and AIDS over the past few years, which has now been supplemented by the Comprehensive Plan for Management, Care and Treatment of HIV and AIDS adopted by Cabinet in November last year.
The child immunization programme has been significantly expanded, efforts to combat escalation in malaria have intensified, and a very successful community-based treatment programme for tuberculosis was implemented.
In addition, substantial policies and initiatives have been put in place to promote more equitable distribution of resources geographically. These have included: the successful implementation of community service programmes for young health care professionals; the initiation this year of a unique system of allowances for health professionals in rural areas and professionals with skills in short supply; and the inclusion of the certificate of need provisions in the National Health Bill.
Realising that financial obstacles are themselves a significant barrier to equitable access to health care, initiatives are constantly being explored to contain spiralling medical costs. The amendments to the Medicines and Related Substances Control Act, and the draft regulations relating to a transparent pricing system for medicines and scheduled substances, are specifically intended to activate mechanisms to increase access to essential medicines. It is anticipated that consumers stand to benefit by between a 40% and a 70% reduction in the cost of medicines when these regulations become fully operational.
And in terrain in which the majority of you are probably most familiar, reforms introduced by the Medical Schemes Act were put in place to ensure that individuals burdened by disease were not unfairly discriminated against. These included requirements of open enrolment, community rating and prescribed minimum benefits, as well as recent innovations such as the inclusion of a chronic disease list in the PMBs.
While significant achievements have been made to ensuring greater fairness and equity in the allocation of health care resources, I will be the first to attest to the fact that huge challenges still remain. Some of these challenges are unique to South Africa; many are challenges experienced globally.
Huge imbalances remain in resources between public and private sectors, and between urban and rural areas, and there are still unacceptable levels of variation between provinces on expenditure on primary care. Attempts to address those inequities are complicated by competing social demands and growing needs in some areas. Significant cost escalation continues in the private sector and there are still inequities and unfairness at a structural level within the medical schemes environment.
As a government, we are committed to addressing these challenges through a variety of measures, including improved planning and allocation of resources. Health facility revitalisation will continue to be accelerated. The hospital revitalisation process will use R911 million in 2004, as part of a total budget of about R2 billion for improving health service infrastructure.
On the budget front, we are committed to: ensuring an appropriate level of funding for the health sector; creating partnerships with the private health care sector; achieving greater equity in the allocation of health resources between and within provinces; and ensuring that primary health care gets an appropriate slice of the health cake.
And very importantly, we are committed to accelerating the process of implementing a social health insurance system in this country to ensure a far greater degree of equity in allocation of health care resources at a national level. A recent Cabinet lekgotla directed the Department of Health and Treasury to finalise recommendations on Social Health Insurance by the end of March.
Our objectives of moving toward a Social Health Insurance system include the following:
* to improve access of lower income groups to quality health care;
* to reduce inequities in health care financing by improving income and risk-related cross subsidies;
* to strengthen the public health system by increasing the revenue available to it; and
* to obtain prepaid contributions from those who are able to pay for health care.
Our current thinking on the Social Health Insurance is that it will be based on three primary tenets: mandatory health insurance cover for specified groups; income-related cross-subsidies among contributors; and risk-related cross-subsidies among contributors.
A key process toward meeting these objectives has been the work, which is taking place around implementation of a risk equalization fund in South Africa. Substantial progress has been made toward this with the recent task teams on risk equalization methodologies and related tax subsidy reform proposals, and the convening of an international panel of experts to review the proposals. Substantive proposals in this regard will serve on Cabinet in the near future.
There can be no doubt then of the commitment of government to continue to ensure fair and equitable access to health services by all South Africa's peoples, through policy, legislation, funding and partnerships with a range of stakeholders.
While all this is going on at a broad structural level, I am acutely aware that our efforts can be frustrated at grassroots level by poor customer service, discriminatory attitudes and unfairness perpetrated against individuals seeking access to care.
Those factors are far more difficult to address at a broad structural or policy level, and that is precisely where a conference such as this assumes so much importance. It creates opportunities to translate the overall vision of government for fairness and equity in health care into a tangible difference for consumers at the level of individual health care transactions.
So for this reason I would again like to express my appreciation to the Council for Medical Schemes, and indeed to everyone who is attending this conference, for your commitment to ensuring greater fairness and equity in health service delivery in South Africa.
I wish you well on your deliberations over the next two days, and very much look forward to receiving a copy of the final fair treatment report, incorporating the input and recommendations emanating from this seminar.
I thank you.
Issued by: Department of Health
19 February 2004
Source: Department of Health (http://www.doh.gov.za)
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