NHI: means to necessary health-care reform
SOUTH Africa’s health system is in dire need of an overhaul in order to realise the prescripts of Section 27 of the Constitution regarding the health of every citizen.
It is a common agreement that Universal Health Coverage (UHC) is the ideal that the health system should be working towards to ensure that our people receive full access to the essential health services they need, particularly those who are poor and marginalised due to socio-economic status, without being exposed to extreme poverty from out-of-pocket spending to receive health-care services.
Health care should not be a commodity, accessible only to those who can afford it. As a basic human right, it should be easily accessible to all those who need it. The National Health Insurance is SA’s response to achieving UHC by improving equity in accessing quality health services while offering financial risk protection.
The NHI, therefore, should not be seen as a political tool to advance an agenda of a few. It should be seen as a tool to fulfil our moral and ethical obligations regarding the health of all South Africans, and a solemn reminder of the responsibility each of us has to work towards ensuring a healthy and long life for all.
It is disingenuous for any official or member of a political movement to claim that all nine million people in SA that are insured under private medical schemes will have to be accommodated in the public sector once the NHI is implemented.
The NHI will function as a purchaser of health services, whether from “private” or “public” health facilities that have been contracted to offer the health services. All resources, whether infrastructure, human or otherwise, will be pooled together, made available to those who need them and paid for at the point of service.
The principles of UHC underline a fundamental feature – social solidarity, which is financial risk pooling to enable cross-subsidisation for all, whether young or old, rich or poor. Every citizen will contribute to the pool based on their ability to pay.
Those who have the means will be at liberty to contribute to a private medical scheme for top-up cover in order to pay for services not covered by the NHI, as will be stipulated in the package of care and the benefits advisory committee.
The NHI bill does not suggest that one has to continue contributing to a private medical scheme in order for them to access contracted “private” medical facilities/services. This is at best a misrepresentation of what the NHI Bill states.
There are undeniable challenges in our health system regarding leadership and governance, old and dilapidated infrastructure, human resource shortages and challenges with fraud and corruption, all of which need intervention.
We cannot deny that the health system is worsening and will eventually collapse if nothing is done. The idea that we have to solve all the challenges before we implement the NHI will deny us progress and the value that lies in working towards and attaining UHC, however long it takes.
The NHI is not a solution to be applied to a perfect system. The solution to fraud, corruption and incompetence requires a “whole of government and a whole-of-society” approach.