South African competition authorities will launch an investigation into the private healthcare industry, where early evidence showed high prices and market distortions, according to Economic Development Minister Ebrahim Patel. Various stakeholders have raised concerns about pricing, costs and the state of competition and innovation in private healthcare. Patel said competition authorities had ruled previously that the practice of setting up common tariffs for medical procedures was uncompetitive. Instead he pointed to a growing trend of increasing healthcare costs and a massive asymmetry of power health markets. Patel said preliminary evidence showed that some that in some cases competition was "prevented, distorted or restricted." Private health providers in Africa's largest economy include Life Healthcare, Mediclinic International and Netcare Ltd, all of whom have benefitted from the growth of the middle classes. The Competition Commission, which can impose administrative fines, is expected to launch the "market inquiry" before September 2013.
Public-Private Mix
The Free State Province in South Africa, with the provincial capital at Bloemfontein, is home to 2.8 million people. But only 13 per cent have private health insurance with most relying on government-operated facilities for their healthcare needs. There are two academic public hospitals in Bloemfontein: Pelonomi and Universitas. In 1997, the government was unable to raise the estimated R825 million needed towards the major renovation of Pelonomi hospital and a partial upgrade of Universitas Hospital. The solution emerged through a public-private partnership between the Philippine national government and the private sector. The PPP was structured for the hospital redevelopment project between three partners.
US Secretary of Health Tommy G. Thompson signed a cooperative agreement that will provide nearly $1 million from the Centers for Disease Control and Prevention to fight HIV/AIDS in a public-private partnership in South Africa. The agreement with the American Center for International Labor Solidarity reflects the department's commitment to continue the HIV/AIDS employee outreach programme at the Ford Motor Company's operations in South Africa. The signing of the agreement came during Thompson's week-long trip to Africa that included stops in Mozambique, South Africa, Botswana and Cote d'Ivoire. Thompson's visit builds upon the Bush administration's strong support for the Global Fund to Fight AIDS, Tuberculosis and Malaria. For more information, please contact Richard Delate.
South Africa’s National Health Department is courting the private sector to build public-private partnerships in the development of the country’s new National Health Insurance (NHI) system. The Department has announced that it considers the issue of improving working relations and trust between the private and public health sectors an important step towards the establishment of the NHI, calling for greater transparency and accountability. Olive Shisana of the Human Sciences Research Council (HSRC) echoed government’s position, arguing that the reluctance of the private sector to work with government on the NHI ‘fails to recognise the long-term benefits for health care’ in the country. The private sector has so far been reluctant to work with government, fearing profit losses if NHI is implemented.
The South African Health Review (SAHR) is an annual publication of the Health Systems Trust (HST), which has been published since 1995. The SAHR seeks to provide a South African perspective on prevailing international public health issues, to stimulate debate and critical dialogue and to provide a platform for assessing progress in the health sector.
The National Cancer Registry (NCR) was established as a pathology-based cancer reporting system. From 2005 to 2007, private health laboratories withheld cancer reports owing to concerns regarding voluntary sharing of patient data.The study aimed to estimate the impact of under-reported cancer data from private health laboratories. A linear regression analysis was conducted to project expected cancer cases for 2005 - 2007. Differences between actual and projected figures were calculated to estimate percentage under-reporting. The projected NCR case total varied from 53 407 (3.8% net increase from actual cases reported) in 2005 to 54 823 (3.7% net increase) in 2007. The projected number of reported cases from private laboratories in 2005 was 26 359 (19.7% net increase from actual cases reported), 27 012 (18.8% net increase) in 2006 and 27 666 (28.4% net increase) in 2007. While private healthcare reporting decreased by 28% from 2005 to 2007, this represented a minimal impact on overall cancer reporting (net decrease of <4%).
Fast food and alcohol advertisements in South Africa could soon be a thing of the past, according to the National Health Department. At a summit held in Johannesburg in September 2011, the Health Minister, Dr Aaron Motsoaledi, highlighted the importance of healthy lifestyles in the fight against non-communicable diseases (NCDs). An Inter-Ministerial Committee on alcohol use and abuse has been set up, aimed at banning alcohol advertising and, despite intense lobbying by the alcohol industry, the Minister has vowed not to change his position. The Minister also aims to target the fast food industry by banning their advertising during children’s television programmes. He says he is working with the relevant industries to make fruit and vegetables cheaper and more accessible, and intends to encourage regular exercise in schools in the form of physical education programmes, citing obesity levels among school children at 23%.
South Africa’s National Department of Health (DoH) has embarked on an initiative to improve and expand access to healthcare services through the contracting of private General Medical Practitioners (GPs) to render sessional service in Primary Healthcare facilities. This initiative is in support of the National Health Insurance (NHl) pilot that aims to improve access to high quality public sector health care services. The initial phase of GP contracting for sessional services will take place in the 10 NHI pilot districts across the country. The DoH embarked on a consultation process started by the Minister of Health in his visits and road shows to the various districts; this was then followed by a letter from the Director-General of Health to GPs to test their levels of interest to participate in this project. Government has advertised for candidates and will soon begin the selection process.
The Australian government has urged other countries to also stand up to the tobacco industry, saying it was confident of victory in a new legal battle over its landmark plain packaging rules. Big tobacco will stop at nothing to intimidate countries to not take appropriate public health measures, said Australia’s health minister, Jane Halton, said at a recent meeting marking World No Tobacco Day. Australia’s new legislation, in force since December, aims to cut smoking rates by requiring tobacco products to be sold in drab green boxes with the same typeface and graphic health warnings. Halton addressed a session of the World Health Organisation (WHO), as the UN agency seeks tougher global measures to reign in tobacco use, which claims six million lives a year. Tobacco continues to cause enormous suffering and death which is totally avoidable, she told participants. New Zealand and Ireland are planning plain packaging rules, despite a tobacco industry-backed challenge to Australia’s law at the World Trade Organisation by cigar-producers Cuba, Honduras and the Dominican Republic, plus Ukraine. The plaintiff countries maintain that Australia’s law breaches international trade rules and intellectual property rights to brands – arguments that failed to convince Australia’s High Court in a case brought by tobacco firms.
The private sector provides care for about 7 million people or close to 15% of all South Africans but consumes more than the total expenditure by the public health sector. The per capita expenditure in the private health sector is about 8 times more than that in the public health sector. Put another way, the public health sector spends about R1000 per patient per year whilst the private sector spends about R8000. The private sector spends an estimated 5.5% of gross domestic product. In addition, this sector employs more doctors, pharmacists and dentists than the public health sector. Clearly, this level of inequity cannot be left unchallenged.