21 November 2019
National Health Insurance is catastrophic for SA’s healthcare and economy
The latest iteration of National Health Insurance (NHI) Bill was gazetted on 26 July 2019 and is open for public comment. It’s a depressing sense of déjà vu. South Africans are no closer to understanding critical details such as how much the NHI scheme will cost, where the money to pay for it will come from, and where the country will obtain the additional personnel (both medical and bureaucratic) to staff the ambitious scheme. However, the government is intent on pushing ahead.
FMF Health Policy Unit member Dr Johann Serfontein notes, “While everyone can agree South Africa needs Universal Health Coverage, the ability of the NHI model to achieve this is highly doubtful”. Serfontein goes on to state, “The government has been telling South Africans for 10 years that the introduction of NHI will magically fix the failing South African health system, but when pressed for answers as to how it aims to do that in the face of overwhelming practical issues and financial concerns, they remain silent”.
Recently, government affirmed via the 6-year long Health Market Inquiry (HMI) that robust competition is missing from both the supply and funding sides of private healthcare, causing systemic cost increases. However, as Mike Settas points out, “The government’s NHI Bill seeks to create for itself a monopolised single payer NHI Fund that will single-handedly undertake the procuring of hundreds of billions of Rands of healthcare services for every citizen of the country. It is further solidifying this monopolistic dominance by banning medical schemes from competing against the NHI Fund”.
The legal aspects of the Bill are of grave concern. As Norton Rose Fulbright Director Patrick Bracher states, “What has been introduced is economically unsustainable, legally unconstitutional and practically unachievable. The Bill is unconstitutional in regard to who it will provide health services to, how it provides those services, and the funding mechanisms for doing so. The State President’s announcement that everyone will have national health insurance by 2025 is demonstrably not possible”.
The FMF advocates that those who can pay for their own healthcare and, generally, do not rely on government provided service, must be allowed to continue to do so. Government should be concentrating scarce taxpayer resources on the poor and destitute, and allowing the private healthcare sector to grow, innovate and expand. Such a healthcare model would not only be good for South Africa’s financial health but would lead to better health outcomes for the poor.