Being appointed Managing Director of the Board of Healthcare Funders (BHF) in September 2017 could well have been perceived as a natural progression for MEDUNSA (now University of Limpopo) medical graduate, Dr Katlego Mothudi, having seen service as a medical advisor and clinical executive for Metropolitan Health, GM and then MD of Aids for AIDS at Medscheme before becoming Executive Head of Operations and Clinical Services at Sizwe Medical Fund. He is also one of the industry fortunates to have enjoyed the benefit of both worlds, not only as a provider and funder, but also as a private and public sector medical practitioner – he had his own GP practice in Brits and was a Principal Medical Officer with the Gauteng Provincial Government and a Clinical Manager with the North-West Provincial Government before entering the funding world. He is therefore acutely aware of the many challenges facing healthcare funding from all quarters, as he explained to Med Brief Africa co-editor, Roy Watson….
RW: I think the first question I have to ask is, having seen all the various medical funding groupings deliberating together at the Council for Medical Schemes’ Fraud, Waste and Abuse Summit a few weeks back, is there a chance of consolidation in the private medical scheme environment?
KM: Whether we will have true consolidation or not we don’t know. But what I advocate for is that, whatever quarter we work from, there has to be collaboration. We have to admit that there have and might still be some ideological differences that cause fragmentation, but the industry must find common touch points in the many technological and operational areas in which we all function.
RW: Fraud obviously being at the forefront right now…?
KM: Yes. Fraud is a touch point as is tariff determination – industry challenges where we shouldn’t compete such as coding and developing protocols as well. There are many areas where we can put our differences aside. We may not get consolidation but definitely need collaboration in these common areas.
RW: Generally speaking, do you still see fragmentation as an obstacle in the way of healthcare reform, universal healthcare being the endpoint?
KM: Fragmentation has always been a problem, probably more so in recent times. There was a time that we all thought that the only fragmentation, or division in healthcare was that between the public and private sectors and that’s where it ended. On the supply side, for example, providers are also divided into various groupings and some not talking to each other. We have numerous representative bodies even on the provider side, including those who represent healthcare facilities, rendering the industry more fragmented. This is not doing the industry any good.
RW: So what has to happen?
KM: We have to find common threads. Healthcare reform actually necessitates this. If we are going to try and map out any common destination, we can’t, as funders for example, do it from our own corners. We need to focus on the needs of consumers of healthcare instead of ourselves.
RW: Although obvious, is this your biggest challenge in private medical funding?
KM: The intention of universal healthcare coverage is to address the three traditional pillars namely access, affordability and ensuring good outcomes. These encapsulate the current major challenges in healthcare. Now, if we look at private funding in South Africa, the number of lives covered, around nine million lives, hasn’t changed much for a number of years now. There has been a slight increase in the number of new members signing up but there’s a corresponding decline in the number of dependants linked to registered members. This means, for example, that a working parent can’t cover all his or her children and ends up picking who should be covered among them – anti-selection! Access, therefore, is still a major problem.
RW: So the private sector is not without its access problems as well?
KM: Definitely. You know, we have also all assumed for a long time that the private sector yields better outcomes, but these haven’t really been measured, at least in a standardised way. Yes, it is easier and faster to get care there, but at what level? Can’t really answer that as there aren’t standardised methods in place to find out. In fact there are those who are punting the fact that if the private sector entities were subjected to the measures imposed on those in the public sector, they wouldn’t pass! This, of course, is one of the concerns emanating from the Health Market Inquiry (HMI) discourse.
RW: How do you see the role of medical schemes under NHI?
KM: There will be changes but schemes won’t disappear. Although we haven’t really figured out how NHI is going to work, it does not preclude the possibility that schemes will eventually provide services to NHI or work alongside it. There were a few tenders that went out last year where government asked administrators to bid for services to vulnerable populations as part of the initial processes of the NHI, so there is space for the private sector to co-exist with NHI.
RW: We have also heard that schemes would provide top-up cover, but how could they do that if, as proposed in the revised NHI Bill, schemes can’t cover conditions covered by NHI?
KM: This I have to agree is contentious and has in fact been flagged by the BHF as a potential constitutional infringement concern.
RW: Overall, are you optimistic?
KM: I am optimistic mainly because there is a wave now towards supporting healthcare reforms as opposed to a few years ago when there were still many opposing them. Obviously now it is just the “how”. It would be disingenuous not to acknowledge the status of public healthcare in the country. That presents an area from which to start in terms of fixing the system at large. As discussed, there are challenges facing both the private and public sectors, so one can no longer wait for someone else to “fix this space”.
RW: And, of course, all this falls in line with your July BHF Southern African Conference theme, “’Convergence 2030 – Healthcare Re-imagined”,
KM: Indeed. What we mean by convergence, as we have discussed here, is how we all can put our hands together to finding solutions to health funding and provision challenges. With these challenges facing us, we are combining the United Nations time line of 2030 and “health re-imagined” to say that we can’t use the same approaches from before to solve current problems. So what we will be looking at in Cape Town will be a new vision with all hands on deck!