Our Health Plan: The DA’s health plan is the best route to a healthy and fair SA

21 November 2016

Today the DA officially launches its alternative plan for universal healthcare in South Africa, which we have titled Our Health Plan (OHP). We believe our offer is the most credible and workable option that seeks to ensure that no person is denied quality healthcare because they are poor.

The DA’s mission, as a national government-in-waiting, is to build an inclusive society where everyone has access to the educational and economic opportunities necessary to get ahead in life. The very first step on this journey is to guarantee universal health care.

For too many South Africans, the circumstances of your birth determine your prospect to access life-saving healthcare. The current status-quo entrenches poverty and inequality and insults the DA’s core values of Freedom, Fairness and Opportunity for all.

This plan before us today is the result of extensive consultation with academic and industry experts, and we believe it is a much better offer than the national government’s plan, National Health Insurance (NHI). It can be rolled out sooner; it is far more affordable; it is fairer; and aspects of it have already been shown to work in practice.

- Faster delivery - Our Health Plan will provide quality healthcare to all within 5-8 years, whereas NHI will take 10-15 years to implement.

- More affordable - Our Health Plan will provide quality healthcare to all at a cost that we as a country can easily afford. It can be implemented using our current health budget, but with an additional R6 billion achieved by bringing the current medical aid tax credit of R17 billion on budget. This would mean that medical aid contributions would no longer be tax deductible. However, the remaining R11 billion of additional revenue would go to reducing the costs of medical aid. The NHI on the other hand is budgeted to cost up to an additional R182 billion per year, which we simply cannot afford.

- Fairer - By bringing the medical aid tax credit on budget, and allocating some of it to build better services in the public health sector, those with medical aid are cross-subsidising those without, an act of health justice.

- Works in practice - Many of the aspects of Our Health Plan have already been successfully implemented in the Western Cape, and the results speak for themselves. The DA-run Western Cape Province has a track record of delivering better health care than any other province. For example, the maternal mortality rate in South Africa is 153 deaths per 100 000 live births, while the rate for the Western Cape is almost half that, at 84.

Our Health Plan is also the most practical approach to universal healthcare, as it aims to keep what should be kept, fix what should be fixed, and smartly extend services that should be extended within the limits of the national purse.

Essentially, Our Health Plan ensures a comprehensive package of quality services within the public health system - free at the point of access to everyone, while retaining and reforming the medical aid system. For South Africans who have no medical aid, the reforms described below and in the full document will deliver improved service at clinics and hospitals, enhanced maternal and child care provision and access to efficient - and free at the point of service - emergency services in urban and rural areas. Those who are on medical aid will benefit from enhanced choice and greater access to more efficient - and free at the point of service - ambulance services.

While the full policy document puts forward our plan in extensive detail, here are some of the most salient proposals contained in Our Health Plan:

- Provide an additional R1 billion per year towards the training of medical, nursing and health professional staff;

- Provide an additional R2 billion per year for expanded maternal and child health programmes for which clinics and hospitals that qualify compete;

- Provide an additional R1 billion for a single number national public-private emergency service governed by an independent board;

Reform the medical schemes so that they compete on the cost and quality of the health services they cover, rather than on the risk groups they target;

- Establish a self-funded post-retirement and unemployment protection regime for medical aid members;

- Set aside an indicative R9,43 billion from the medical aid tax credits to reduce the monthly contributions of medical scheme members;

- Reform the Council of Medical Schemes (CMS) to have a board that is independent of the Minister of Health and the entities it (the CMS) regulates;

- Introduce autonomous public hospitals and district health authorities governed by independent boards and with wide operational discretion allocated to executive heads to carry out their mandates;

- Insists on having clinically trained chief executives of hospitals and managers of health facilities;

- Extend nationally the Western Cape’s reliance on inter-sectoral collaboration with non-governmental organisations (NGOs), private companies (Clicks), pharmacists, private physiotherapists, general practitioners (GPs) and complementary medicine and allied healthcare professionals;

- Extend nationally the Western Cape’s system of having three service streams (1) home and community based services provided by community health care workers; (2) intermediate care; and (3) primary health clinics, community health centres and day centres;

- Provide for expanded clinic-building programmes especially for under-served areas nationwide by devoting an additional R2 billion per year to building and staffing clinics;

- Allocate a universal subsidy to every South African citizen and legal resident, irrespective of whether or not they are covered by the public or private health systems. The value of the subsidy would be set in relation to an affordable and comprehensive package of services available within the public health system;

- Propose state sponsored reinsurance for small medical schemes;

- Ensure health provision will be free at point of service for both those who have medical aid membership and those who do not. Medical schemes will pay in a more structured manner for public services used by their members as the quality thereof improves. R2 billion of the medical tax credit revenue is made available for this purpose; and

- Eliminate the funding gap for those who fail the means test but cannot afford medical aid, by eliminating the means test itself.

This entire plan is realizable within our current resource envelope meaning we can achieve universal healthcare for all, without requiring any new or additional taxes.  Hospitals under DA governance will be places where people are cared for and lives saved; not places where people go to be abused and to die.

Our Health Plan will provide a solid foundation on which South Africa can build an inclusive society.

Issued by Wilmot James, DA Shadow Minister of Health, 21 November 2016