Andy Gray
One of the recurring themes in healthcare at present is the call for closer collaboration between the public and private sectors. The chasm that separates these two areas of practice can perhaps best be demonstrated by reference to expenditure on drugs – almost equal amounts are spent by each sector each year, but this represents totally different expenditure per capita. In the private sector, drugs constitute some 30% of total healthcare costs, while in the public sector the figure is about 10%. This bald fact brings home how far we are from providing equitable access to services of comparable quality in the two sectors. The public-private mix is usually punted hardest by those promoting the role of the state as purchaser rather than provider of services. Plans to establish private sector pharmacies as accredited providers of service to district health authorities are still in their infancy, and bedeviled by legislative barriers. But can the sectors learn anything from each other while these structural impediments are removed? The quality of service provided in the public sector is often attacked in the media, with repeated examples of indifferent, rude and inefficient public servants being presented. While the government has embarked on the policy end of the remedy – for example with the publication of the Batho Pele White Paper - the private sector can provide some of the basic tools for making this a reality within our health facilities. Total Quality Management programmes in many private sector hospitals have been successful in placing the needs of the patient first. Perhaps we should see some structured effort to bring those tools into play in the State – ‘privatisation’ of a very different ilk. At the same time, the private sector can learn much about the rational use of medicine, so that their drug expenditure can become closer to the international norm of about 8-10% of total healthcare costs.
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