“..all healthcare providers – even private entities – will be performing a public function in the furtherance of equality, dignity and the right to access healthcare.”
In order to facilitate dialogue around the licensing regime for healthcare facilities and the way it affects competition in the private healthcare sector, the Health Market Inquiry (HMI) held two engagement sessions, on 28 February and 1 March, to obtain both policy clarification and participation from relevant stakeholders. The first session was a closed discussion with the National Department of Health and the Provincial Departments, while the second was open to other stakeholders affected by the licensing regime, including healthcare facilities. The objective was to facilitate HMI’s framing of appropriate recommendations on a suitable licensing regime that achieves an adequate balance between the right to healthcare, the promotion of competition and new and innovative models of healthcare delivery. Participation in discussions around the licensing regime has particular weight in light of the upcoming implementation of the NHI.
The licensing regime is a national policy, which guides the provinces in the licensing process in order to create a standardised and transparent approach. The policy involves guidelines to assist provinces with implementation, such as those relating to application information, the constitution of a provincial advisory committee, licensee monitoring and reporting, sanctions and remedies, as well as an appeals and complaints procedure for rejected applications. A commitment to universal health coverage as well as the importance of a comprehensive transformation procedure came out in discussions with the NDoH and the provinces.
Particular submissions were selected to be presented at the second session to promote discussion. RHAP was in attendance for these discussions and was indeed the only representative of civil society. In our view, the worries from many of the stakeholders seemed to be around the uncertainty of the role of the certificate of need in obtaining a license, the practice code number system administered by the Board of Healthcare Funders, and more broadly, the need for a transparent, consistent and lawful license application process.
One of the presentations, given by SAMA was incredibly understanding of the maldistribution of healthcare and the need for a regulatory regime to take into account inequity of access and quality of healthcare. Particular mention was made of rural areas. On the other hand, the presentation by Netcare utterly rejected the notion that the licensing regime should be framed by the right to healthcare, and held instead that it should be framed by the healthcare providers’ right to property and freedom of movement. It was comforting to see other stakeholders in disapproval of such a position, however it is worrying that such a big player in South African healthcare considers their services first and foremost as profit-driven instead of rights-driven. It is our suggestion that Netcare and other stakeholders who hold this view, begin to reconcile themselves with the fact that, particularly with the implementation of the NHI, all healthcare providers – even private entities – will be performing a public function in the furtherance of equality, dignity and the right to access healthcare.