The healthcare landscape after the elections: What can we expect?

14 May 2019
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Will elections lead to positive changes in SA’s Healthcare system? This burning question has been posed repeatedly in the
run-up to the elections and despite innumerable promises of better healthcare by the majority of political parties, the answer is unfortunately, “no.” The reality we are faced with in South Africa is that we have to resign ourselves
to yet another term in office for the ANC, despite the abysmal failure of Public Health under their 25 year watch.

Recent months led to swathes of promises of improved services and “Free quality healthcare for all” under the guise of the
proposed NHI Policy, despite South Africa being no closer to this promise of universal health coverage (UHC) under NHI, than with the launch of the Green Paper nine years ago. The Green Paper, at least, made reference to costing of
the NHI, something which of late, has been dismissed by the Minister of Health as a “Thumb-suck.” Whenever the Minister is asked about whether we can afford to implement NHI, he has repeatedly chosen to indicate that “we cannot afford not
the implement NHI”, rather than reflecting any figures of the potential costs of the system.

While the World Health Organisation (WHO) stresses that one should not get bogged down in a costing process, they do
indicate that in cases of a major policy shift, costing is essential. NHI is, no doubt, a major policy shift, with a complete overhaul of the healthcare system being advocated. The reason the WHO advocates as such is to avoid the
exact situation South Africa is currently facing. A lot of time, resources and energy is being applied to implement the NHI, without the country having any idea whether we can afford it or not. Ireland did the same thing and when a
costing was done, they had to scrap their entire NHI policy. South Africa requires a similar bold step, but the ruling party is simply too deeply entrenched in the NHI ideology to admit unaffordability and defeat, resorting to fresh, pragmatic thinking.

Treasury is more pragmatic in its approach, with clear indication that there is some consideration, at least, by Treasury
on how unaffordable the NHI model might be for South Africa. Unused NHI funds have been moved towards solving more immediate problems, such as shortages of staffed posts and funding of Internships and community service posts, without
any indications of additional funding for NHI projects going forward. The Minister of Health has failed to provide any answer on which government facilities are going to render services in the NHI if more than 90% of them would not currently qualify to contract with the NHI fund. A major overhaul of the system is required, but not by installing a Single Payer Funding mechanism. The system needs to be overhauled by installing competent managers at all levels of public healthcare
and looking at ways to extend the population using the private healthcare sector. Spare capacity in the private sector needs to be taken up by state patients, but that would mean introduction of interim funding measures for
this. The Minister is not keen on taking any steps that would be perceived as admitting failure of NHI, so he would rather fiddle while Rome burns, than to pick up a bucket and start carrying water to the blaze.

One can only hope that the next term of office for President Ramaphosa would lead to the introduction of a Minister of
Health who is capable of admitting that there is a problem and looking at concrete ways to deal with it, rather than reverting to the sweeping statement that NHI will solve all healthcare systems’ issues in the country, eventually.
If visible steps are not taken to strengthen the public health system, the passage of time makes the possibility of NHI being implemented more unlikely with every month that passes. Rising malpractice costs in the state will eventually
eat up all the resources which are supposed to be allocated to the NHI. As with Eskom, we need to admit our public healthcare is in a crisis. The president has indicated that Eskom is too big to manage effectively and is being broken up
into three parts, in order to survive. 
The question is how a National Health Insurance Fund, which will be twice the financial size of Eskom, will be administrated without running into similar management problems as the ailing power utility? SASSA, COIDA and the
RAF have all failed in their mandate to effectively pay out only a fraction of the funds which the NHI Fund will be called upon to distribute. One can only hope that the pre-election NHI rhetoric is now behind us and that the next
government will focus on fixing the public health system to provide quality healthcare to all, instead of dreaming about NHI.

Dr Serfontein is a Healthcare Consultant to SAPPF, a member of the Free Market Foundation Health Policy Unit, and a published novelist under the pseudonym Jean Cerfontaine.

This article was first published in Med Brief Africa on 29 April 2019 



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