Panelists

• Moderator: Dr. Tim Quinlan, Research Director, Health Economics and HIV/AIDS Research, University of KwaZulu-Natal
• Ms. Adjo Mfodwo, Executive Director, Appiah and Associates
• Dr. Willem A. Landman, CEO, Ethics Institute of South Africa
• Dr. Solly Benatar, Bioethics Committee, University of Cape Town South Africa
• Dr. Jeff Sturchio, Vice President, Corporate Responsibility, Merck and Company

Summary

Dr Benatar: Sees SA as a microcosm of the world—you find all the good things and all the bad things; if you were someone from Mars, what would see? Of total global health expenditures, 87% is spent on 16% of the population. The research agenda is driven by those with money and disparities in wealth and profession are growing, so providing healthcare for everyone will require not being purely concerned with making money.

Dr Landman: Freedom = developing human capacities; the question is: should every member of a society have access to health care? This does not have to be philosophical question, but rather a concrete one that should be seriously examined in every society.

Ms. Mfodwo: You can’t look at healthcare industry ethics as being different from a society’s overall ethical characteristics—the health system is a product of the overall system; Why ethics? Very large amounts of money are spent both in the private and public sectors—some players are interested in realizing personal gains at any expense, hence the existence of corruption, which we have witnessed in several cases.

Dr. Sturchio: Right now is no time to be complacent when it comes to ethics and the global sphere. It is important to have an emphasis on rule of law and transparency.

Representative from the Department of Agriculture: The participant feels a great sense of compassion emanating from the panel. She raised the dilemma of calculating the worth of a human being or the health of a human being in terms of investment and noted that this was a fundamental issue to be dealt with in all sectors, but specifically the private sector.

Mr. Barnes: Unlike TB treatments, HIV/AIDS programs for treatment become costlier over time as you have more people taking drugs for the rest of their lives. Who has the responsibility to fund ongoing treatment regimes?

Dr Benatar: All too often people are taking a linear approach to healthcare, we need a different paradigm for understanding complex systems, we need to stop thinking about what needs to happen in 2 years time and start thinking about what needs to happen in 20 years, a courageous leap if you will.

Question: why is Africa so adverse to private healthcare delivery?

Dr Benatar: You have to look at the healthcare system under apartheid in South Africa and look at South Africa now. Now the public sector has weakened as the private system becomes more and more profit-driven, with hospitals, insurance companies, and medical supply companies charging exorbitant amounts while doctors themselves are not sharing in the profits. Profits are not being funneled into human capital, the backbone of a well-functioning health system. In the past, the private sector bolstered the public sector in South Africa; that is no longer the case.

In South Africa, 15% of the population is covered by private healthcare. The country is trying to introduce a low-income medical scheme that will reduce quality spectrum of services, but increase participation. The government already has in place an employees medical scheme. How? An economy of scale was created to push prices down, negotiations took place with private hospital groups, the HMOs were challenged to come up with products to service low income populations, and public facilities were used to create middle level of services for this new income group.

Question: Brain drain: is there a solution?

Response: Its not as helpful to train healthcare workers abroad – it is important to train the person in their home environment. Also, we need to improve the conditions of those in rural areas – not just increase their salaries, but provide better conditions and benefits.