Private healthcare in South Africa is among the best in the world, and it is not uncommon for patients from developed nations to travel to our shores in order to take advantage of the excellent medical care that we offer. For the current discussion there are probably only two salient points to make about the private healthcare system: 1. It is very good; 2. It is expensive. Dr Manto Tshabalala-Msimang, the minister of health, seems to object to one or both of these points, and is making moves that endanger the private healthcare system in its entirety. She is trying to have the National Health Amendment Bill signed into law, which will essentially introduce price controls for private healthcare. If the bill becomes law, South Africa can expect to see large scale disinvestment in the private healthcare sector, and perhaps a collapse of the sector altogether. According to Dr Morgan Chetty, chairman of the KwaZulu-Natal Managed Care Coalition, ‘The general perception is that the minister of health is trying to eliminate the private sector.’ The minister is under the impression that healthcare is a special type of business that, because of its importance, is not entitled to follow the model of every other commercial venture, i.e. the pursuit of profit.

On one level she is right, healthcare for all is essential, and cannot be based solely on how much money each person has in their pocket. That, however, is where the public sector comes in. The public healthcare system is under the direct control of the minister, and its mandate is to provide quality care for all who live in South Africa. It is funded by taxpayers - among them private healthcare companies, private medical practitioners, and people who do not use the public health system but pay for their own healthcare -  and is thus not driven by the need for profit.

Unfortunately, the public healthcare system in South Africa has seen a dramatic decline under the custodianship of Dr Tshabalala-Msimang, and the minister has repeatedly booked herself into private facilities for her own healthcare needs. Mismanagement in the public sector is, of course, not entirely to blame for the problems, since the scourge of HIV/AIDS has put unprecedented strain on the public sector in particular. With HIV/AIDS comes a wave of illness and infirmity the scope of which the medical community could not prepare for, and there is little doubt that even the best-case scenario for public healthcare would see it under severe pressure. South Africa has not experienced the best-case scenario, however, as the HIV/AIDS crisis has been handled extremely poorly, and political infighting (such as last year’s Madlala-Routledge debacle) has damaged an already ailing system.

With the threat of price controls now looming, it is as if the minister is admitting defeat. It is a great pity that to this day she refuses to take a stance of working with the private sector rather against it. Public-private partnerships could alleviate much of the pressure that the public sector is under, but the current atmosphere of distrust and animosity precludes any substantial progress in this regard.

With a huge immuno-compromised population in South Africa, now is not the time for the public healthcare system to worry about whether richer people are paying too much for their purchased care. Rather the health department needs to build bridges that will allow it to mobilise some of the substantial resources of the private sector, since this is the way that the poor will truly benefit. Things like price controls certainly won’t be making any friends, and Dr Mamphela Ramphele has likened them to ‘price regulation in Zimbabwe that, in the name of reducing prices for consumers, resulted in empty shelves’.

- Marco MacFarlane