Photo: Dr Anuschka Coovadia, CEO of Usizo Advisory Solutions
Citing World Bank figures, Coovadia said SA’s healthcare expenditure as a percentage of GDP has for 20 years tracked on average at around 8% compared to an average of 12% for high-income countries and 4,5% for low-income countries. By comparison, life expectancy for SA has grown from 48 years to 64 years while low-income countries increased from 40 to 64 years old. High-income country lifespans had increased from 69 to 81 years – all between 1960 and 2020.
In a positive but inverse correlation, South Africa’s out-of-pocket expenditure has remained well below the global average, edging out high, middle, and low-income countries. Low-income countries’ out-of-pocket spend is way higher than the global average, dropping over the last two decades, but remaining significantly higher than middle-income countries and way higher than high-income countries.
The gap widens
Coovadia said that by 2040 high-income countries are projected to spend nearly 46 times more on total health expenditure per capita than low-income ones.
“There’s a strong relationship between increased pooled resources and improved universal healthcare, (UHC), performance – with increased global consensus on UHC’s ability to improve population health outcomes in an equitable, sustained manner,” she added.
She stressed that countries assessed by the World Bank had either nationalised, market-based or insurance-based systems – or a mix.
All these systems had different advantages, but the disadvantages for nationalised systems were long waiting times, limited choice, and higher taxes. Market-based systems had the first two, though admin costs were duplicated. Insurance-based systems had limited access based on affordability, higher costs (premiums) and higher admin costs.
She listed the top eight big global healthcare trends ‘to watch’ as virtual care, artificial intelligence, personalised medicine, population health, value-based care, patient engagement, digital technology and UHC.
Covid permanently changed healthcare
Coovadia said that since Covid-19’s global disruption, healthcare systems would never be the same again and the provision of wellness services as a core pillar of holistic healing would be a key part of the future.
Behaviour would move from caring for the sick to keeping people healthy, length of life to quality of life, reactive to proactive care, and from a siloed approach to integrated care. Diagnosis and treatment would evolve towards screening and prevention, while provider-centric care would move to patient-centric. Physical consults would become a mixture of physical and virtual while having a doctor for life would morph into having a “doctor at my convenience.”
She said the South Africa macro-economic picture was not encouraging with slow economic growth (1,8% GDP), high unemployment (38% and for youth over 50%), infrastructure and inadequate economic inclusion challenges plus inadequate transport, power, and water. There was a large budget deficit and high debt levels while social issues included poverty, inequality, crime, and corruption.
With health expenditure currently at 9,8% of GDP, 44% of it in the public sector and 56% in the private sector, there were 775 hospitals with 153 000 beds, 51 000 physicians and 312 000 nurses, making it the largest healthcare market in Sub Saharan Africa.
She described the SA healthcare ecosystem and its regulation as, “complex, fragmented and rigid,” although the latter system was ‘robust and underpinned by the Constitution.’
The survival of medical schemes would depend on their ability to diversify, collaborate with healthcare providers and other stakeholders, adopt technology, provide personalised and user-friendly services, (patient-centricity), and advocacy to influence policy while ensuring that the NHI was implemented in a way that was fair and sustainable for both the industry and its members. Funders would need to back healthcare that was accessible, affordable and of good quality, providing a decent level of engagement and satisfaction to patients and providers.
She concluded; “it comes down to a choice: doing nothing, or making small consistent efforts that will reap exponential benefits.”