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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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.