“National health insurance (NHI) is a health financing system that is designed to pool funds to provide universal access to quality, affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status. NHI will be implemented through the creation of a single fund that is publicly financed and publicly administered. The health services covered by NHI will be provided freely at the point of care. NHI will provide a mechanism for improving cross-subsidisation in the entire health system. Funding will be linked to an individual’s ability-to-pay and benefits from health services will be in line with an individual’s need for health care. Implementation of NHI is based on the need to address structural imbalances in the health system and to reduce the burden of disease.” – Chapter 2: definitions features and principles of NHI, White Paper
Change is incredibly important in South Africa’s current climate. The old adage says, “If it’s not broken don’t fix it.” The truth is, it’s far more broken than we are often willing to admit. Adversity and pain often teach us to endure even the most dysfunctional situations; we find it difficult to trust the process that will eventually emancipate us. It is with these truths in mind that I would like us to examine our current healthcare system.
Our healthcare system is currently built on a framework which was used during the apartheid years with some post-lliberation modifications. In a publication by Simmone Horwitz (WITS UNIVERSITY, 2009) titled “Heath and healthcare under apartheid”, it shows that before 1994, the healthcare system was divided according to racial groups and “private and public”. The implications of this were that everything from funds, facilities and the workforce were distributed according to racial groups’ priorities. She states ,”Apartheid policies had a very damaging effect on the health of the majority of South Africans.”
In a section of the publication entitled implementing inequity, she explains: “The private health sector consumed 60% of health care resources, and employed the majority of doctors, dentists and pharmacists, whilst serving only 20% of the population.”
To appreciate the consequences of that approach on our current healthcare system we need to reflect on our current statistics.
The white paper for NHI reveals the following: “In the private sector, there are 83 medical schemes funding the health needs of only 16.2% (8.8 million lives) of the population. Spending through medical schemes in South Africa is the highest in the world and is six times higher than in OECD countries. South Africa spends 8.5% of GDP on health and 4.1% of the GDP is spent on 84% of the population, the majority utilizing the public health sector whilst 4.4 % of its GDP is spent on only 16% of the population in 2015/16.” NHI point – 81 and 92
Comparing the two, pre and post-apartheid healthcare, it is evident that there has been a skewing of resources to serve one group more than the other. The poor and the underdeveloped rural areas suffer most but are certainly not the only ones implicated.
Designed to ensure that all health care services and resources are managed by one body, NHI seems to promise that all the funds being spent on healthcare will be fully available and accessible to all South Africans. It basically means we all have, and are managed by, the same medical aid. No one is denied a healthcare service that they need. That serves the poor, the middle class as well as the wealthy. It also seems too good to be true. However, it is evident through the assessment of our past and current healthcare system that we have been unsuccessful to provide quality healthcare to all. The rise in healthcare cost continues to pose a threat to the burden taken on by the under-resourced public sector and to the pockets of all medical aid users.
It is important to emphasize that NHI is not without its flaws and its implementation will be gradual and challenging. The World Health Organization prescribes that there are 6 building blocks to a healthcare system: Leadership/governance, healthcare financing, health workforce, medical products and technologies, information and research and service delivery. South Africa is arguably suboptimal in the first four building blocks, especially in the public sector.
As a medical doctor practicing in the public sector and seeing the impact of our current healthcare system on everyone who engages with it, from the patient, to the health professionals, I can’t help but believe that this is a system that will be the most fair. I strongly believe even the designers of NHI will never be able to remove all our doubts and fears.
This new venture is a giant leap for our country. Its success lies not only in the hands of the government, but in the hands of each and every one of us. It’s a call to all of us, to consider our humanity above our privilege. Personally, I hope it’s a great success because, “we cannot possibly expect to assist people in their journey towards healing if we are comfortable with the dysfunction of our service” -Dr Lerato Khatle