SA’s health system is a disgrace. So too is the ANC’s reckless promise that National Health Insurance (NHI) will fix it all.
No-one can take issue with the NHI’s stated ambition to provide everyone with quality health services that are free at the point of delivery, regardless of their means. There is something truly unconscionable about SA’s status quo, in which the poor rely on a corrupt, maladministered and largely unreliable public health service, while those who can afford to do so buy their way out, either paying out-of-pocket or using medical schemes and a variety of health insurance products to cover the costs of private providers.
The trouble lies entirely with the way the government intends to realise its laudable goal.
The National Health Insurance Bill, passed by the National Assembly last week, sets the stage for sweeping reforms that will ultimately cause the government to purchase all the health services required by the population, via a central fund run by individuals selected by the health minister and approved by cabinet. Medical schemes will be largely phased out, permitted to only cover services not provided by NHI, and the state will ultimately have sole control over where health facilities are located and where doctors work. Precisely what these services will be, and exactly how they will be financed, has yet to be determined.
The uncertainty created by this vagueness, set against the backdrop of an ever-growing list of state failures ranging from electricity outages to the collapse of passenger rail services, is causing untold damage. Despite extensive input from academics, civil society organisations, healthcare professionals, medical schemes and healthcare companies, little has changed between the NHI green paper published in 2011 during a period of vigorous economic growth and the National Health Insurance Bill now being considered by the National Council of Provinces as the country teeters on recession. Virtually all constructive criticism has fallen on deaf ears, as the governing party has obdurately driven through a policy born more of politics than reason.
As the ANC continues to sell the electorate the fantasy that NHI is the panacea for all ills, it continues to turn a blind eye to the decay in public hospitals and clinics, and wilfully neglects vital reforms that could expand private healthcare access. Almost four years ago, the Competition Commission presented the health department with a blueprint for improving competition in the private sector and giving patients a better deal, the culmination of a five-year investigation into the healthcare market that drew on the expertise of top analysts. That report is still gathering dust on a shelf, because, as the health department reminded us once again last week, it believes NHI will deal with it all.
Business Leadership SA has rightly warned that NHI risks making things worse for everyone, with private healthcare provision effectively shuttered and the state unable to provide services.
Employers are appalled at the prospect that their staff may be compelled to use a state-run service with no scope to purchase better care, while healthcare professionals are terrified that their ability to live and work where they choose will be compromised. All of this will make it harder to recruit professionals from overseas and spur South Africans with globally sought-after skills to seek employment elsewhere.
Health minister Joe Phaahla has consistently batted away criticism of the NHI and questions about its financial feasibility with glib reference to the UK’s National Health Service (NHS). He argues that since the NHS was founded in the aftermath of World War 2 despite the UK’s weak economy and stiff opposition from doctors, and is now regarded as a national treasure by political parties across the spectrum, the same can be done in SA. What he conveniently neglects to mention is the NHS is a shadow of its former self, with 15% of people waiting more than a fortnight just to see a GP and patients in some parts of the UK waiting almost two years for a hip replacement.
Health is no ordinary commodity. It is a human right, enshrined in SA’s constitution. Eroding South Africans’ existing access to healthcare services, imperfect though they may be, and threatening people’s freedom to earn a living is setting the ANC government on a path that will almost certainly reach the Constitutional Court. The governing party clearly know this: what it doesn’t seem to realise is the damage it is wreaking even if its ill-considered policy never comes to pass.
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