Hon Speaker, this is the answer to Question 231 to the Minister of Health in relation to the private health sector's being labelled "brutal". I have had a discussion with the Minister and my response is based on that discussion.
The Minister of Health labelled the private health sector system as being "brutal", where people are denied access to care in private facilities, even in emergency situations. In some cases, due to administrative problems with their medical aid cover, they are expected to pay tens of thousands of rands upfront, immediately, before they are attended to medically. Also, in some cases where the medical funds are exhausted prior to the full treatment being provided, they are refused further treatment.
There is no problem in the relationship of the ministry and the Minister with the private sector. The Minister himself meets regularly with representatives from the private sector. The concern of the Minister is the affordability of private health services in South Africa; hence the proposal that has been made, of a National Health Insurance, NHI, system.
We would like to call on all South Africans, in both the public and the private sector, to embrace the World Health Organisation, WHO, guidelines in finding solutions through the NHI system to effectively managing the hospital-centred system, which has a strong curative focus instead of a disease prevention and promotion focus; secondly, to deal with the fragmentation in the approach of health programmes and service delivery, so that we build an integrated health system that is more effective; and, thirdly, to deal with uncontrolled, unregulated commercialisation of health care which undermines the principles of health as a public good.
In some instances, even financially stable families are thrown into poverty due to the high and unjustifiable cost of health care. Some examples of costs which are high and unjustifiable and which have been brought to the attention of the ministry include: R18 000 for what we call a D&C, which is dilation and curettage, mainly for women who have had an incomplete abortion or abortions; R30 000 for a perianal abscess, which can be a relatively minor operation; and R67 000 for the evaluation of a person who had a car accident and came into the hospital walking.
Then there was R500 000 - half a million rand - for a laparotomy for a peritoneal abscess, and in addition there were separate surgeon's fees of R23 000 and separate anaesthetic fees of R3 000. Finally, there was another R700 000 for the same patient for a repeat of the operation, and that was just before the patient died! Other overservicing by the private sector was where, instead of a procedure that was worth R200 that a child of 10 years needed, an offer was made for a root canal treatment worth R20 000.
I have no doubt that hon member Waters and the House will appreciate the choice of words of the Minister of Health, given that he had to save taxpayers' money recently. He effected a saving of R4 billion meant for HIV- positive, mainly poor patients from the claws and jaws of the pharmaceutical industry just recently. This money was meant for antiretroviral treatment, ART. If the Minister had not intervened, it would have become part of the profits of this industry.
The Minister has signed a service level agreement with the President to increase the life expectancy of South Africans. He is taking his job seriously. Let us continue supporting him in this endeavour and ensure that we built partnerships. Thank you. [Time expired.]
Speaker, it is unfortunate that the Minister of Health is not here to reply to his own remarks. The high costs in the private sector can be attributed to the lack of regulation by the department itself, and the Minister and Deputy Ministers failing to do their duty in regulating the private sector.
If we are to improve the quality of health care in the public sector, we will need the expertise of the private sector. Labelling them "monsters" and "brutal" is not only destructive, but reminds us of our recent past, where the previous Minister would have made such irresponsible statements.
Our top priority must be to bring together both health sectors in order to improve the quality of health care for all in this country. In order to show his commitment and maturity in achieving this goal, the Minister should apologise unconditionally for his remarks to the private sector.
The Minister is not labelling any individual person in the private sector. Also, the Minister and the ministry have certainly leveraged the expertise in the private sector, and we will certainly need the expertise in the private sector as we build an NHI system and a better health system. The Minister is objectively assessing, which we agree with, the state of the private health system as it is, and as South Africans currently feel it.
I must also say that this is not unique to South Africa. The three areas that the WHO guidelines deal with, including the uncontrolled commercialism of health care, are not unique to South Africa. It is an international problem that all of us, public and private sector, must come together and join the ministry in dealing with. I thank you.
Mr Speaker, I have three short questions for the Deputy Minister.
Just one is enough.
Okay. I think, Mr Speaker, we are well aware of the differences in costs. Recently it was publicised what the difference in costs is in both the private and state hospitals for circumcision or male genital mutilation.
We also know that, for example, many people prefer to go to private hospitals. Even my old friend, the late Harry Gwala, chose a private hospital before he would go to Grey's Hospital, which was a good state hospital.
My question to the Minister is: Would the Minister not consider three examples of public-private partnership hospitals in the Eastern Cape which are extremely well run as examples of places where private medicine and state medicine work together very constructively? They are the hospital in Humansdorp, the Settlers Hospital in Grahamstown and the hospital in Port Alfred.
As we discuss the whole question of the NHI system, I think those are the case studies that we need to look at in regard to whether they will assist to achieve the objectives of the NHI. We also recall that in the Green Paper that has been released for public comment, the NHI also indicates that the service providers will be accredited. So, if those are the models that are in line with the objectives of affordability, efficiency and effectiveness in regard to the health of the population in that area, they will be assessed accordingly and, if found appropriate, they will be accredited. So, indeed, the health system is integrated and the ministry is committed to working with all South Africans in that regard.
Mr Speaker, the question is about how the Minister intends to improve his relationship with the private health sector. The Deputy Minister has answered and said that there is no problem with the relationship between the Minister and the public health sector, but then why does he use words such as "monsters" and "brutal"? What type of a relationship is it then, if people call each other "monsters" and "brutal" and so on? I think the right thing to do is for the Minister to withdraw what he has said and apologise, as that will improve the relationship.
Hon Speaker, on Wednesday I left Cape Town for Bloemfontein and the region of Gariep as part of my district visits. I incidentally sat next to a woman who was one of the professionals, a psychiatrist, who was going home to her mother. When I had explained the NHI to her, she shared with me that she had been jogging, had sprained her leg and had gone to the nearest hospital, where she was refused treatment because she did not have a credit card and could not pay upfront; and she could not prove that her medical aid cover would cover her. So the system is monstrous and brutal, and it is unacceptable.
The Minister has no problem in relating to the private sector. He works very well with the private sector. He consults the private sector and they enhance his work. I think we should agree that these incidents are inhumane - some call them capitalism without a heart. Thank you.
Speaker, Deputy Minister, the truth is that maybe the people are not happy with the use of the words "monster" and "brutal".
Furthermore, the truth is also that even if you have a medical aid and you go to a private hospital, at the point at which the funds are exhausted you are told to get out! That is really the issue. The private sector must apologise for to the people they chase out after finishing their medical aid funds. [Applause.]
Indeed, I think many South Africans, especially the middle class, who are members of medical aid funds know that during this period, towards the end of the year, most of their cover is exhausted. Furthermore, if they have catastrophic illnesses like cancer, or they land in ICU, they may actually be told to get out, in a way, because their funds are exhausted.
So let's work together. The Minister is working with the private sector and the Ministerial Advisory Committee. Even the NHI has the private sector involved in it, and a number of ministerial advisory committees in various areas have private sector industry involved with them and there is continuous dialogue. Let's find common solutions to this problematic system. Whether we call it monstrous or brutal, it is inhumane.
Policy and legislation dedicated to development and management of housing co-operatives
204. Ms B N Dambuza (ANC) asked the Minister of Human Settlements:
Whether his department has any policy and legislation in place that are dedicated to the development and management of housing co- operatives as an instrument of social and economic growth and development; if not, why not; if so, what are the relevant details?