A non-negotiable priority right now before any meaningful work can be done to sort out the healthcare problems in South Africa must be breaching the trust deficit that exists between the private and the public sector.

“We can’t just decide the one is better than the other and shut down the one and keep the other one. We’ve got to recognize they both have strengths,” Dr Stavros Nicolaou, representing Business for SA (B4SA), stressed during an SA Health Industry Summit panel discussion yesterday.

“How best we leverage these strengths,” he continued, “must be a discussion without any self interest – what is going to give the best optimal outcome not the best ideology.  There is a track record of public and private having worked together so it gives me a lot of hope that you can start bridging and translate.

“Let’s also start implementing policies – start talking less and implementing more,” Nicolaou added.

Of equal import, he stressed, was to make the difficult and hard choices that needed to be made, up front: “The more we defer those and delay them the worst the situation becomes. How, for example, can we be sitting 23 years down the track with 130 000 HIV deaths a year when we realized we had a crisis in 1999? It’s unacceptable, so let’s make the difficult choices and let’s invest in the right areas.

Healthcare, he concluded, must be seen as an investment and not an expenditure: Unfortunately far too many people see it as an expense.  It’s not! It’s an investment in people that will grow this economy. There can be no bigger priority right now than recovering the economy and getting it back to 3% and beyond.”

In similar vein Barry Childs, of Insight Actuaries and Consultants, in his address on the burden of disease, told Summit delegates that in the private sector it was becoming more and more critical “with each passing year” that progressive regulatory reform is brought to fruition.

“We really have not done anything meaningful in the last 20 years. PMBs, for example, have not been meaningfully updated since 2003. They need to be completed, they need to be flexible and need to allow for innovation so that the private sector can do what it does best which is innovate.

“We need to embrace this concept of value based care. I’m using the term very broadly for all stakeholders, both vendors and providers with aligned interest in the sector. We need to think much more carefully about strategic provision of care, strategic purchasing of care and value based care,” he pointed out, “is a very useful framework to remind everybody what it is that we’re trying to achieve in the system.”

Healthcare professionals, said Childs, need to be open to explore new models:  “We’ve heard about teamwork, which is mostly non-existent in private sector – we need to do much more there. And then private sector training, which would be a 25 minute talk on its own but is really one solution to the human resources for health problem that we have. Again there we have good policy. The Human Resources for Health (HRH) policy document was updated two or three years ago but unfortunately if you look 10 years before that it was almost the identical policy and really nothing has changed from an implementation point of view.

“We seem unable to unlock a skills development process and there’s really no need for that,” he added when concluding the point.

“We could harness private sector participation.”

Also obligatory was incorporate wellness into the health risk pool, which, Childs concluded, should not only be about insurance based catastrophic protection: “We need to find a way to incorporate wellness behaviour improvement and incentives into the pool so that you don’t have high out of pocket expenses if you happen to go to hospital .

“We need to find a way to work with members, patients to align interests at that level to make sure that behaviours are improved so that we don’t reap the whirlwind of this non-communicable burden of disease that’s going to affect both sectors materially.”