DDF Health Care Policies vindicated

Direct Democracy Forum’s (DDF’s) health care policies have been vindicated by a top South African medical aid expert.

In an article How the government took away the hope of private healthcare from millions of currently uninsured”, Eve Dmochowska, who has made knowledge of the provision of medical aid and medical services her business, slates the ANC government for leaving the public health system in total disarray and promising delivery of a universal public health system only in 14 years time. In the article she points out that “the government is already running a universal healthcare system, and failing miserably. Everybody has access to state healthcare already, and those who cannot afford the healthcare receive it for free.” So, we ask, what is going to change in 14 years time?

Ms Dmochowska also asserts that in the light of their abysmal track record in health care, government should extract themselves from the provision of health care and that “If the (medical aid) schemes were incentivised with R3-billion reasons per month to make private primary healthcare work for 10 million people, I bet you they could. And I bet you they would”.

So what is Ms Dmochowska proposing if not in essence the DDF’s health care policy.

We further quote Ms Dmochowska to make the point:

The government would benefit greatly if the burden of providing primary care to 10-million people was removed from the public system. It could improve the service levels to the remaining 25-million uninsured. Or it could even outsource the entire primary healthcare problem to the private sector: pay the premium and leave the logistics to the private sector. In return, the government would further benefit from lower public hospital admissions levels as good primary care is preventative of long term health problems”

This is almost exactly what the DDF are proposing, except we also propose to privatise nearly all the public health care delivery systems. Not only would it extract government from the invidious position of overseeing a system engaged in an ever downward spiral, but it would also put the patients in the driving seat. It says to the service provider, ‘provide the service and we the patients will support you. Don’t provide the service and we will go elsewhere, because we can’.

This is not just handing over a huge market to the private sector to profiteer from but instead the patients will insist that they must deliver in order to profit from the system. As does Ms Dmochowska, we also bet they could and bet they would, both deliver to their patients and profit from that process.

We at the DDF think this is a good thing and we doubt it would take fourteen years to deliver.

See also how to pay for a basic income grant and take a look at DDF policy on the Basic Income Grant (BIG) and DDF policy on the Total Economic Activity Levy (TEAL).

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South Africa’s Hospitals from Hell

We made the point in our gender equality post that political equality was worth nothing if you die early from poverty and ignorance.

Just how serious the situation is, particularly for our rural women, is brought home by this alarming report in the M & G on-line about maternal mortality in Mpumalanga hospitals.

The Direct Democracy Forum have comprehensive health care policies that will broaden access to health care throughout the land and institutions and practitioners who failed to provide appropriate and effective health care for their patients will not be allowed to continue their practices, while institutions and practitioners who did provide such care would flourish and prosper.  DDF health care policies will provide affordable and quality health care for everyone in South Africa, irrespective of their wealth or lack of it, or their position in society.

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The buck stops at the ballot box.

SA 17th most gender-equal country.

This BBC report indicates that according to the World Economic Forum (WEF), South Africa is the 17th most gender equal country in the world. I guess South Africa should be proud of that, that is, until you look at the details.

On a range of 1 (most equal) to 4 (least equal), South Africa scores a 1 overall; a 4 (least equal) for health and survival, a 2 (mostly equal) for education, a 3 (mostly unequal) for economic participation and a 1 (equal) for political empowerment. So let’s not get too proud, we have a long way to go for all categories but for political empowerment, and political empowerment is just not that important if you are going to die young, probably from a combination of poverty and ignorance.

Direct Democracy Forum policies clearly indicate their commitment to gender equality, the best possible education, health care and economic opportunities for all. The DDF are committed to at least a score of 1 on each of those categories.

The buck stops at the ballot box

1 Military Hospital

What image does one have when 1 Military Hospital is mentioned? Top rate medial facility, probably the best in the country.  That’s what I would have thought, until I read this Mail and Guardian report on 1 Military Hospital.   Now I wonder?  Is the country’s flagship hospital in the same state of disrepair as the rest of the country?  What a shame.

The Direct Democracy Forum cannot imagine the circumstances under which an emergency communications system in an elite hospital escapes repair over two years but that would not happen under a DDF administration.  The DDF would make sure that the skills and resources needed are made available to make every state medical facility fully functional.  View the DDF health care policies for a glimpse of what is possible. 

The buck stops at the ballot box

 

Health Care – Getting it Wrong

Here is a sorry tale about Eastern Cape’ medicine non-delivery system.

What is it about South Africa and the the Eastern Cape in particular, that we can’t get our act together?  We previously posted on the poor delivery of education in the EC , Teachers Without Jobs, Children Without Teachers, to mention just a few topics, and now, since May 2013, medicine delivery is also failing in the Eastern Cape.

It does not seem to matter enough that children are not being educated and the sick are not being medicated that they tolerate delivery systems that don’t work.  It is all a sad and shocking state of affairs that suggest the country is falling apart at the seams while the vultures circle and pick up choice profits that are going for doing business with government and not being held accountable.

A Direct Democracy Forum administration would not tolerate any of this, not for one moment.  We could not in all consciousness tolerate such poor delivery results and such sad consequences.  The DDF can only point to DDF policies and stress that when we say we will deliver, we mean exactly that.

The buck stops at the ballot box. 

How to render private GP’s ineffective!

How to render private GP’s ineffective!  Make them work in an already dysfunctional system.

In contrast, the Direct Democracy Forum envisions a system which allows patients of  public health systems, be they NHI patients or whatever, to be attended by private practitioners and institutions at their normal rooms, clinics or hospitals.  That way a lot of pressure will be removed from otherwise overstressed public health institutions and access to medical care will become much easier for public health patients. 

That being said, it will also encourage the public health system to improve its service delivery, which it will need to do because it would effectively be competing with private sector health services for patients.  This is exactly what the DDF would like to see happen, with only effective institutions surviving.  See DDF Health Policies.

The buck stops at the ballot box.

 

Unhealthy Health System

In February 2013 the Direct Democracy Forum was told that the Yeoville Clinic had been without power or water since 14th December 2012.  The DDF was also told that the municipality had obtained a quotation for some R50 000 to rectify the matter but did not have the budget for that expenditure.  As recently as a month back the the DDF were told that the Hillbrow clinic was unable to supply risperdal and generics, commonly prescribed anti-psychotics, and other commonly needed drugs, because the municipality had not paid the suppliers.  Although the DDF tried to alert the press that there seemed to be something systemically wrong with the finances of the municipal health services, that effort seemed to be like pouring water into a bottomless well.

Then came this report “Why has Gauteng run out of ARVs?”.  The report is so shameful on so many levels as to be unbelievable.  But sadly it seems to be believable and to vindicate DDF concerns about the possible systemic collapse of Johannesburg municipal health service finances. 

As with the DDF post on the R100 Million Deals,  the DDF have multifaceted policies to bring municipal finances under control through the application of DDF policies on TEAL and to make municipalities more accountable to their constituents through  DDF Local Government Policies.  In addition, comprehensive DDF Health Care policies will broaden access for everyone to quality health care,  so patients will never be turned away from the provision of adequate care, anti-retroviral drugs and other desperately needed medications.

The buck stops at the ballot box

‘Our way’ Part 1 Medical Costs

Why does South Africa always seem to get it back to front?  Why is that when our society invest fortunes in critical sectors of the economy (such as medicine and education) outcomes are always so dismal?

Part of the reason is that we insist on doing it our way instead of adopting best possible practices.

To illustrate the point, take the high medical costs we have to bear.  Government’s response is to introduce legislation that will effectively allow government to regulate prices that medical practitioners can charge.  No cognisance is given to the costs medical practitioners face and have to cover in order to practice, from the costs of education and training to the costs of premises and labour and equipment and supplies.  “No No No – that is unfair criticism” government would argue.

The point the Direct Democracy Forum wish to make here is that by selectively applying price control without controlling prices of the entire supply chain we will merely drive even more of South Africa’s practitioners to foreign lands than we already have.  Just what we most need when the high costs of medical services are a result of the under-supply of medical resources.

Contrast that with the DDF‘s approach. 

  • The DDF will actively encourage members of the profession to remain in South Africa and encourage those practicing elsewhere to return to the country.
  • The DDF will ensure the supply chain is properly resourced so the medical profession can practice their profession properly, professionally and profitably, to the maximum benefit of their patients.  
  • The DDF will target an optimal balance of resources and personnel so as to benefit both the supply side and the demand side for the profession.
  • The DDF will encourage the integration of the public and private health care service providers so as to raise the standards of the public health care sector to those available in the private  sector, without penalising  the private health care sector.
  • DDF Health Care Policies will make it profitable for the private sector to become actively and voluntarily involved in the public health care sector.

Additionally, and as a matter of urgency, the DDF will stop the practice of renewing patents on medical drugs and supplies beyond that reasonably necessary to protect the genuine commercial interests and cover genuine development costs of drug and supplies developers.  In that respect, the DDF will adopt the best practices adopted internationally.

Taken together these policies will have the effect of opening the market to fair competition and provide more practitioners, generic drugs and supplies than are presently available and significantly reduce the costs of medical treatment to all sectors of society.

The buck stops at the ballot box.

Health Care:

Background:                                          PDF: Policy Statement Health Care

Goals: 

  • The purpose of Direct Democracy Forum (DDF) health care policies are to improve the health care delivery system through a process of incentivisation and privatisation.
  • It is anticipated that this will occur in stages and over time:

Stages:

  • 1) Incentivise public health care systems with bonus systems based on delivery and outcomes for health care units (HCUs).  A health care unit is any hospital or clinic or practice run or previously run by the state.
  • 2) Shift burden of salaries from the state to the HCUs based on delivery and outcomes.
    • This would probably be voluntary, that is state employees who wished to remain state employees rather than HCU employees could probably do so but would be unable to participate in the HCU profit share schemes and share ownership and etc. (see below).
  • 3) Offer profit sharing schemes for participating staff of HCUs also based on delivery and outcomes.
  • 4) Offer share ownership of HCUs for participating staff of HCUs,  in partnership with the state.
  • 5) Disinvest the state from health care delivery systems in favour of the private sector.

Payment for services:

  • The DDF will install a Basic Income Grant (BIG) system and recipients will receive as part of the BIG package, paid for membership of a national health insurance scheme (NHIS), much like existing private sector medical aid schemes except it would probably be run under the auspices of a Sovereign Wealth Fund.
  • Private sector medical aid scheme members will be able to use the HCU facilities as well as private health care facilities, as also will members of the NHIS have access to both sets of facilities.
  • Whichever scheme you are a member of will pick up the payments for services rendered in accordance with the rules of your scheme.
  • It would probably be possible to be a member of both the NHIS and private medical aid schemes.

How to fund the NHIS:

  • A deduction of around R600 per month per beneficiary from the UBI/BIG will in all likelihood adequately fund the NHIS (National Health Insurance Scheme) but could be adjusted up or down if needs be.
  • The arithmetic for that is as follows:
    • Assume a GDP of R3 Trillion.
    • The nation’s health spend is said to be 8.8% of the GDP = R3 Trillion X 8.8% = R264 Billion (includes public and private resourced health care).   
    • Assume a Citizenry of 35 Million each getting a UBI/BIG, from which is deducted R600 per month and paid over to the NHIS.
    • So contributions from the UBI = R600 X 35 Million per month X 12 (for a year)  = R252 Billion.
    • The point being that the R252 Billion contributions from the UBI/BIG are in the ballpark for the national health spend of R264 Billion. 
  • So a NHIS funded from a UBI/BIG is doable. 

Points to ponder:

  • Public health care workers would, in time, be paid based on services rendered rather than just for turning up for work.
  • The NHIS would probably be the single largest buyer of medical services and would just as probably have a sobering influence on medical costs and medical aid costs.
  • Health care patients would be free to use the service providers of their choice and service providers would, in theory, rise or fall based on the quality and quantity of the services they provide and their reputations in the health care market place.
  • It may be necessary to provide state run health care facilities for sectors of the health care market that cannot be run profitably by the private sector on its own.  Such state health care units may be run exclusively by the state or preferably, in partnership with private sector health care providers.

Conclusion:

The DDF  believe there should be an element of competition between medical facilities in order to stimulate the provision of improved services and improved patient experiences and outcomes.  Members of the public can attend the facility of their choice, the different institutions will be encouraged to compete with one another to provide better services and thus attract more patients and more revenue, from which the institutions and their staff will benefit.  

In short the DDF will be introducing rewards for good service delivery and consequences for poor service delivery.   The DDF believe this will benefit all sectors of the medical profession and their patients, who at the end of every day, are the most important players in a health care system.