Feature Article: Healthcare should be a matter of choice, not dictate

‘Satanic’ and ‘ genocidal’ is how Minister Motsoaledi referred to pharmaceutical companies that developed vaccines, antibiotics and a plethora of other medications that have increased life expectancies throughout the world and helped humanity to enjoy longer, happier, and more productive lives. Only governments have ever committed acts of genocide, and, usually, it is the private sector that has had to rectify matters.

The Times piece by Katherine Child (Hospitals: lucky if you get out alive, Apr. 1) paints a bleak picture of the state of medical care in government run facilities across the country. The piece quotes Wits Law professor Bonita Meyersfeld, who is regularly approached by patients and frustrated doctors seeking redress for their poor treatment. Meyersfield states, “Hospitals have no budget for medico-legal cases and have to use their own budgets to defend cases that arise from poor care at their institution, which are extremely expensive. This was at the cost of paying suppliers for equipment and drugs”.

Private healthcare is one of the most regulated sectors in the South African economy but Minister Motsoaledi is still not satisfied. His inordinate focus on the private sector is no doubt because he is fundamentally opposed to any private sector activity. He is desperately seeking to introduce more and more regulation before the implementation of the proposed National Health Insurance (NHI) policy.

In addition to the shackles it imposes on private sector companies, government is also seeking to control individual behaviour. Deputy Minister of Health Dr Gwen Ramokgopa has stated that for the government to implement its planned NHI policy successfully, all South Africans will have to reduce their salt intake. The supposed underlying logic being that if government is to pay for healthcare (that really means the taxpayers since they are government’s only source of revenue), then government should be allowed to dictate to us, the taxpayers, what we can and cannot do with our own bodies.

The idea of a national health service fuels the erroneous general perception that government is the foundational source of our health and is thus entitled to regulate our behaviour. Generally speaking, the healthcare system in this country can be described as a sea of government-run healthcare sector mediocrity punctuated by private healthcare sector islands of excellence. Government representatives seem to find it difficult to accept that the too few pockets of excellence are not driven by altruism; but by the profit motive. If you want efficient and effective medical care provision, you need to think like a rational person and ask yourself, ’Why don’t we reward, instead of punish, the pockets of excellence and try to get more people to attend these facilities?’ But it seems government is intent on us getting to the point of nationalised healthcare before the people of this country will realise how bad things can get.

The problem is that when it comes to the health care sector, the government is both player and referee. The minister has revealed that he is against the “commodification” of healthcare (i.e. opposed to the for-profit private sector) and seeks to control every aspect of the private healthcare sector. These controls reduce competition, put upward pressure on prices, and deter entry by potential competitors. More disturbing is that government is so preoccupied with trying to control the private sector that it is ignoring the suffering that its own medical malfeasance is causing patients in the public sector.

Dr Motsoaledi’s disdain for the private sector is not confined only to South Africa, but extends across the border to Lesotho. Referring to the launch of the public-private partnership between Netcare and the Lesotho government where Netcare holds 40 per cent of the Tšepong consortium, which won the tender to build, finance and run the Queen Mamohato Memorial Hospital (QMMH) for the Lesotho government, Dr Motsoaledi said, “When the minister of health in Lesotho came to invite me for (the launch of the project), I told her it’s not going to work.”

Lesotho health ministry operations adviser for health planning and statistics, Majoel Makhake, though, has since stated, “As far as we are concerned, this is a very good project, and the (health) outcomes are very impressive”. Indeed, Boston University found QMMH’s health outcomes vastly superior to those of its predecessor: stillbirths were down 22%, mortality fell 41%, and paediatric deaths from pneumonia dropped by 65%.

It is well known that many private clinics in South Africa provide a valuable service to low income people yet many people believe that there should rather be “free” government-run healthcare clinics and hospitals. Critics of private health care view private facilities as a symptom of government failure. They do not see the private sector rather as the solution to the very real and tragic problem of inadequate and inefficient medical service provision.

Government is attempting to extend government health care provision to a greater percentage of the population despite people’s revealed preference to attend private facilities. Government is closing its eyes and remains stubbornly intent on pouring more money than it can afford into fixing a largely dysfunctional government-run sector. It should, instead, preserve what scarce resources it has available by allowing poor people to choose for themselves which facility they would prefer to attend. The health care services provided by the government could be purchased from a competitive private sector at a lower cost than the real cost of government provision of similar services if like is compared with like.

Source: This article may be republished without prior consent but with acknowledgement to the author. The views expressed in the article are the author’s and are not necessarily shared by the members of the Foundation.

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