Break Up The Ministry Of Health
By: Andreas E Peltzer
THE problems in the public health sector are well-known. Everyone understands: The whole debacle is not just a problem with nurses or doctors. But the structure of the health system taken over at independence is the root cause.
Behind it is a general perception of a government acting as a benevolent dictator and knowing what is good for its people. With the best of intentions many governments in the world act like that. They see a government as a single entity able to maximise the health of its society.
In this situation it may be helpful to look at the Public Choice Theory developed by James M Buchanan since 1949. It criticises the idea that government has to take over tasks where the private market fails. This thought is dominant especially in countries with a lot of poverty. Mainstream thinking says the poor need government in all spheres: feeding schemes, public education and health care plus a plethora of other support schemes.
It is true, poor people can’t have a heart operation unless government pays for it. But this isn’t the same as saying we need a governmental health sector with 10 000 employees. While the people of Namibia in an exemplary process agreed to have a constitution, they never had a chance to debate about the health system they would prefer.
Such a discussion may seem obsolete as everyone just wants the best possible system of health care. But the issue of medical quality gets mixed up here with the issue of the most suitable institutional arrangement. As we already have a lot of private health facilities in major towns the question narrows down to what choices we have in areas where no private practitioners operate.
There may be a lack of health care in the country’s wide open spaces and there is a lack of health care for the economically disadvantaged sector of society. While private doctors try to adjust their services so that even the basics are affordable for the relatively poor, citizens who have no income whatsoever can’t be served by a market for health care.
Here the public-choice theory comes in again explaining to us that the opposite of a market economy isn’t just the state monopoly with its political influences and rent-seeking interests. Especially in the health sector there are in fact many tested institutional options to cater for people with no or little income.
The best-known model probably is the general health insurance paying just for everyone with or without an income. But the world of insurance has created also some more specific models: for example a health insurance signed with your local hospital. A flat rate paid for the family once a month guarantees you services by your local health facility for the month.
Another possibility is the cooperative services. A community may run a clinic as a cooperative: A medical health worker may provide first aid in a building maintained by the community. A smaller town may establish a hospital including private facilities, cooperative services as well as insurance-based services.
Healthcare is not the ‘government’s business’ . There are lots of opportunities for all the other institutions and lots of chances for the creation of new partners in healthcare!
Even the government isn’t required to look like one big elephant. The Ministry of Health and Social Services’ health facilities could be split into several trusted institutions providing healthy competition amongst each other and the private sector.
A lot is possible. Just have the courage to begin a creative process !
*The author has been working in the management of Catholic health facilities for a decade.
Dear reader, Gwen Lister has travelled with work.