The Big Read
National Health Insurance: just what is Discovery banking on?
● The National Health Insurance (NHI) fund is set to shake up South Africa’s healthcare sector but experts caution that it will not be a success if South Africa does not first resolve existing problems.
The country’s public healthcare system is plagued by staff, medicine and supply shortages, poor infrastructure and surgery backlogs. The private sector — although providing better quality healthcare — is characterised by prohibitive and ever increasing costs.
The disparities in both sectors were highlighted by Statistics SA’s General Household Survey 2017 which found 71.2% of households made use of public healthcare facilities as their point of access. House holds that access private healthcare amounted to 27.4%.
To bridge the gap and ensure all South Africans have access to free, high-quality care, the Department of Health has introduced the National Health Insurance Bill, which will pave the way for the NHI fund. However, the bill does not elaborate on where the budget for the fund — to be implemented in 2030 — will come from.
The Treasury has allocated an additional R4.2-billion for NHI over the medium term, to be funded through an amendment to the medical expenses tax subsidy.
Alex van den Heever, professor of governance at the University of the Witwatersrand, said for the NHI scheme to be effective the government needed to change the way provincial health services operate, rather than “throwing money at them”.
The NHI framework did not propose to do anything to resolve the issues in the medium term until 2026.
“What makes the [NHI] a distinctive or unusual proposal is that it claims to be creating or establishing universal coverage in a system that already has universal coverage. But instead of actually trying to incorporate an uncovered group into a public scheme, it’s proposing to incorporate a covered group, medical scheme members,” he said.
Van den Heever questioned using a tax subsidy to fund NHI. “It is implied that in bringing the group in, they are somehow going to improve the subsidy for lower income people. There are hard fiscal constraints around whether you can de facto increase the value of the subsidies going from current taxpayers to other people,” he said.
Momentum Health head of sales and marketing Damian McHugh said although countries such as the UK, Germany and Australia have universal healthcare, it is difficult to use them as case studies.
“It’s taken Germany 125 years and it’s still not perfect. So it is a very complex thing to get right and in a vast majority of those countries you have a very high employment ratio, which means a lot of people are paying tax so there’s a lot more money in your system.”
He said the NHI was a good plan that was not necessarily doomed to fail but could only succeed if South Africa could get quality healthcare to a broader base of people without affecting the pockets of excellence in the public sector and private sector.
Head of orthopaedic surgery at Wits Dr Mmampapatla Ramokgopa said: “It is very clear that we are battling, our hospitals and clinics are not run in the way we’d expect them to be.”
Continuing challenges the public healthcare sector was facing, particularly at hospitals, were the “the small battles” that needed to be won before an NHI scheme could be implemented.
“When you run short of oxygen in a hospital, what do you call it? This has happened at Chris Hani Baragwanath Hospital, which is supposed to be a centre of excellence.”
“What case do we have now [to implement NHI], as inefficient as we are?” Ramokgopa said.
However, it seems that Health Minister Aaron Motsoaledi will push forward with his plan to implement NHI, regardless of the concerns raised. In his introduction of the fund last month, he said he was aware of concerns that the system needed to be fixed but NHI was not a matter of debate
What case do we have now, as inefficient as we are?
Dr Mmampapatla Ramokgopa Head of orthopaedic surgery at Wits