LETTER: NHI cannot cure SA’s public and private healthcare

In the article, “It is time for SA to realise the promise of universal health coverage” (November 3), former New Zealand prime minister Helen Clark writes: “By fast-tracking the implementation of NHI [National Health Insurance], SA can further demonstrate its commitment to equity, solidarity and resilience. My hope is that SA will ... accelerate its NHI reforms and build a health system that truly leaves no-one behind.”

Unfortunately, based on its design, incentives and the state of public healthcare in SA, the NHI will not achieve quality healthcare for most South Africans.

According to the World Bank, in 2019 SA’s health expenditure as a proportion of GDP stood at 9.1%. A lack of money in the public sector is not the problem. According to the Office of Health Standards Compliance (OHSC), in 2020/21 just 5.9% of establishments in the Northern Cape, 3.6% in the Free State and 1.9% in Limpopo were compliant with best practice and clinical management standards. According to the SA Institute of Chartered Accountants, between 2011 and 2014, of the 1,427 public hospitals and clinics it reviewed, only 6% met a 70% compliance pass rate.

Pooling all the resources of the public and private sectors into the hands of the NHI fund and board — the members of whom are to be appointed by the given health minister — is a textbook path towards perverse incentives and destructive outcomes.

The NHI will not cure what ails SA’s public and private healthcare sectors. That will require long-term, difficult political work, because it will need to break into vested political interests in the bureaucracy and organised labour.

It is not moral, nor responsible, to try to sell South Africans on the NHI as though it can bypass myriad legislative and policy causes behind poor public healthcare. To do so does no service to citizens and will not deliver quality, affordable care for which they have struggled for generations.

Chris Hattingh

Centre for Risk Analysis

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