Hard to imagine NHI ever being successful

About a week ago, health minister Zweli Mkhize introduced to parliament the long-mooted National Health Insurance (NHI) Bill. The thinking behind NHI is to ensure the same standard of health care to all South Africans regardless of their income bracket. In theory, it is a good idea as it seeks to bridge the divide and ensure no-one is denied quality care because they do not have medical insurance or cash to pay upfront. But in practice, it is hard to imagine that it could ever be successful.

Our government, which allocated about R222bn to public health care this financial year, has failed dismally to provide a quality health care service in public hospitals and clinics. With such a bad track record, and no evidence backing up its convictions that NHI will work, it is nonetheless pushing ahead to ensure the scheme is fully implemented by 2026.

While there are still a lot of unknowns about how exactly it would work, what services/procedures it would cover or exclude, and what exactly this would mean for medical aid firms, we do know that the 16% of South Africans who contribute toward medical aids will be footing the bill.

The 16% will, in essence, contribute what they normally would to medical aids to what one presumes would be an additional tax levy.

How it would work practically is, if you are registered to an NHI-accredited primary health care facility, you will only be able to consult a specialist if you are referred to one by a doctor or nurse at the primary health care facility.

If, for some reason, you head straight to a specialist, the cost will not be covered by NHI. Some procedures will not be covered by NHI and for those you can either take out “top-up cover” from a medical aid firm or pay cash.

For this to work it will essentially need a seamless, thriving health sector. But the reality on the ground is far from it. We have a health system characterised by shortages of medicines, incompetence (albeit there are a number of shining stars who go the extra mile for their patients) and a lack of professionalism.

There is a legitimate fear that with NHI, the standard of health care will be lowered across the board.

And when that happens, there are no real winners.