The National Health Insurance (NHI) Bill’s passage through parliament last week is being triumphantly hailed by the ANC as a key milestone towards achieving universal health coverage. Nothing could be further from the truth.
This is not a piece of legislation that has been developed in a rational process but a blunt, ideologically driven instrument that has been bludgeoned through each step of the public consultation process with an eye on the ruling party’s political calendar, be it an ANC conference or an election. At no point since the green paper on NHI was released for public comment in 2011 has either the executive or the legislature reshaped it in any meaningful way, despite legitimate and constructive critiques from a variety of stakeholders.
With a general election looming large, it is hardly surprising that the National Council of Provinces simply rubber-stamped the bill. Clearly under pressure to get the job done, it ignored even the technical corrections suggested by the health department, since any amendments would have required assent from the National Assembly and delayed the whole thing.
The challenges with SA’s health system are well documented. The public health system is deeply corrupt and poorly managed, and all too often fails patients in their hour of need. The office of the health ombudsman has published a series of investigative reports cataloguing the horrors inflicted on state patients And all the provincial health departments bar that of the Western Cape are haemorrhaging money to inept political appointments and crooked procurement systems.
Access to the generally high-quality healthcare services offered by the private sector is largely the preserve of those with the means to dig into their own pocket or pay for medical scheme membership.
No-one in their right mind would argue that this is acceptable. The trouble is the NHI Bill is not going to fix any of it. In fact, it risks achieving exactly the opposite of what the ANC is promising.
The bill lays the legislative groundwork for establishing a central NHI fund that will buy services for the entire population from public and private providers. It is to be the sole purchaser, with medical schemes barred from offering cover for benefits provided by the NHI fund once it is fully implemented, effectively merging SA’s two-tier health system into one.
The ANC is assuring the electorate that under NHI everyone can go to local private hospitals when they are sick, and that services at public hospitals will be massively improved because there will be more money. But this is simply not true. Not only has the health department itself admitted that NHI will take decades to implement, but it is utterly naive to believe that voluntary medical scheme contributions can simply be redirected to the NHI fund by raising taxes.
A central fund overseen by ministerial appointments is ripe for plunder. And putting the squeeze on medical schemes will destabilise the private healthcare sector, deter investments and create such an uncertain working environment that young healthcare professionals will simply emigrate. The result will be less money and fewer doctors, and a worse deal for everyone.
The NHI Bill is heading for the president’s desk. It is time for him to call out the health department’s hollow promises and send it back to parliament for a complete overhaul.
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.