Amanda Jitsing

Long waiting times, dirty health care facilities and reports of hospital acquired infections are challenges faced by millions of South Africans using public healthcare services on a daily basis. Collectively, these issues reflect the generally poor quality of health services provided by the public sector. While failings in the public sector are widely reported on in the press, the quality failures of the private sector are more nuanced and often overlooked.

In contrast to the problems faced by the public sector, private healthcare in South Africa has become over-resourced, inefficient and wasteful. Rising prices for medical care mean that fee paying patients receive less for more. With little option of substitution between public and private health services, private sector healthcare providers are able to extract high profits from fee paying patients with no check on the appropriateness or quality of the services they provide.

Thus, to some extent, the poor quality of health services may be explained by the fact that a large part of the population relies on an under-resourced, over burdened and poorly equipped public healthcare system. However, a weak and fragmented regulatory framework is also responsible for poor quality health services in both the public and private sector.

Currently, the Health Professional Council of South Africa (HSPCA) regulates the health professions in aspects pertaining to: registration; education and training; professional conduct and ethical behaviour; continued professional development; and compliance with healthcare standards. The South Africa Nursing Council was established to regulate the nursing and midwifery professions to ensure safe and quality practice. Other regulators such as the Pharmacy Council and Medicines Control Council regulate key elements of the pharmaceutical value chain. Finally, the Council for Medical Schemes protects the interests of members of medical schemes and ensures fair and equitable access to private healthcare financing.

Economic regulation is carried out by the National Department of Health which retains the right to regulate prices within the health sector. As such, regulation in the sector is largely targeted at healthcare professionals, medical products and devices and prices. In other words, to date, there is no regulatory oversight over the actual processes and activities involved in producing health services; and no-one to ensure that these activities are carried out in a manner that promotes efficiency while ensuring the safety of patients within the healthcare system.

The National Health Amendment Bill currently being debated within the National Assembly introduces a new scheme to regulate the quality of health services. It establishes the Office of Health Standards Compliance which is tasked with monitoring compliance by health establishments against acceptable norms and standards. To achieve this, the Office will inspect and certify health establishments (public and private), monitor indicators of risk and investigate complaints relating to norms and standards.

Regulating the quality of health services will offer numerous clear benefits to South Africa.

First, any new regulatory scheme which improves the quality of health services is likely to reduce the disparity between public and private sector care; this is especially important as the country prepares for the implementation of any form of national health insurance. Second, requiring healthcare providers to meet minimum standards within the public sector improves allocative efficiency by directing resources to priority areas within the healthcare system. In other words, compliance with minimum standards will mean that more resources are spent in areas of the healthcare system where they are needed most. Finally, it is widely recognised that the regulation of quality standards improves value for money for the patient by fostering patient centred practices over the long term.

Over the past two years, DNA Economics has been contracted to provide extensive regulatory advice and support to the National Department of Health in the drafting of this bill.