Motsoaledi’s healthcare challenge
Aaron Motsoaledi is adamant he can overhaul SA’s healthcare system but many detractors say it won’t work
HIS HANDS are clasped, as though he’s about to pray. There are those who believe the health minister will need all the prayers he can get if the ambitious new plan that promises good healthcare for all becomes a reality.
Aaron Motsoaledi leans forward, his elbows on the polished mahogany desk in his Pretoria office, as he contemplates our question: does he truly believe the National Health Insurance (NHI) plan will work?
There are plenty who don’t – many critics regard it as a badly conceived mess that will end in shambles, cost vast amounts of money and strip resources to the bone.
“Of course I believe in it – wholeheartedly,” Motsoaledi says. “It’s the only way we’ll usher in quality healthcare for everyone. I’m not the only person who’s saying it’s needed – it’s in the National Development Plan, which was accepted in parliament by all parties, but when I want to implement it then they start asking questions.”
On the face of it, NHI is admirable. If it’s successfully implemented, everyone in the country, regardless of income or employment status, will have access to the same doctors and facilities, including those currently only accessible to people with medical aid.
Yet Motsoaledi acknowledges his detractors – and even some supporters – have questions. “Yes, it’s a good idea,” they say, “but how are you going to start it under the present healthcare system?” It’s a fair question because there’s no denying the disastrous state of public healthcare.
Parliament’s portfolio committee on health summoned provincial health MECs to the house in July. MPs wanted answers after a report from the Office of Health Standards Compliance found that only five of the 696 health facilities it had inspected in 2015 and 2016 had reached the required level.
Submissions from the provinces make for unsettling reading.
In the Free State 400 cancer patients are awaiting radiation treatment. There are two machines but one is broken so the province is trying to lease another.
Legal bills as a result of malpractice suits are mounting. Mpumalanga reported an “estimated liability” of R7,6 billion, while the Free State is facing claims worth R2 billion and the Northern Cape R1,4 billion.
Gauteng burned through R22,8 million in “fruitless and wasteful expenditure” in the current year, and has accumulated R443 million in wasteful expenditure from previous years.
There are more than 4 000 vacant posts in North West and about 4 400 vacancies in the Free State.
Mpumalanga is also understaffed and heavily dependent on Cuban doctors and help from Gauteng for higher levels of care. But it lacks the funds to employ new staff so it’s been using its overtime budget to do so.
In the light of all this, it’s little wonder some are calling the NHI plan madness. How can we introduce a whole new system when the health department can’t get its current house in order?
THE minister waves his arms and nods. “It is true that for the health insurance to happen we have to reorganise the public health system,” he says. He admits staff shortages will be a headache because 80% of specialists are in the private sector and they currently take care of 16% of the population.
“The problem with the private healthcare system is that when your medical aid is exhausted they say, ‘now go, tsamaya (leave). Your money is finished.’ They advise you to go to the public sector where you’ll be treated until you recuperate. NHI is going to fix all these anomalies.”
His critics, he adds, say he must first fix the public health system before implementing NHI.
“No, see what’s wrong with that kind of statement. They still want us to separate citizens – those who go to public healthcare and those who go to private clinics and hospitals.”
Money is all that’s needed to overhaul the health system, Motsoaldei says. Once funds are pooled – the money that the government and citizens spend on healthcare – there’ll be enough to provide resources for everyone.
“I’m eagerly waiting for people to take the NHI plan to the Constitutional Court. The Constitutional Court judges will defend it – healthcare is a right and the judges will do everything to make sure it’s the right of the people.”
The 2017 Statistics SA household survey found that 71,4% of households used public clinics and about 27% indicated they’d go to private doctors and private clinics or hospitals if they could afford it.
The minister says the state subsidised private healthcare by R57 billion this year but that money benefits only those who can afford medical aid.
“Tell me why they mustn’t treat you in a private clinic or hospital when you don’t have medical aid, even though you contribute by paying tax. The government gets money from personal tax (such as via salaries), VAT (which even the poorest must pay), corporate tax from companies and there are surcharges collected at our borders and deposited into the treasury.
“The point is, the poor pay tax, which is used to subsidise private clinics and hospitals every year.” By this, he’s referring to the fact that SARS reimburses medical payments that have been made when your medical aid savings run out.
Motsoaledi wants to bridge this gap and ensure all South Africans have access to free, high-quality care.
“All the available money must be put in a pool to serve everybody.”
MOTSOALEDI is passionate about helping the poor. He tells the story of a child whose mother works as a domestic helper in Pretoria. The child nearly drowned in the family’s pool and the homeowner took the child to a private hospital because the government hospitals in Tshwane were full.
“The only ICU available was in a private hospital because it’s reserved for only 16% of the population of 57 million citizens.
“If a public hospital is full, the private sector must admit patients if they have space. After all, they get subsidies from the government.
“You can see the disparity and anomaly. That’s why we must have universal healthcare coverage in the country. Our vision is for everyone to have access to an equal standard of care regardless of income by 2030. For that to happen, you need a common fund.”
South Africans need to be patient, he says: the introduction is planned to take place in three phases over the next 12 years.
Motsoaledi is adamant this will work. “Those who don’t believe it will must think again. There’s bias against the poor and this must be stamped out,” he says.
‘All the available money must be put in a pool to serve everybody’