NHI now has a woolly number, but what is the cost?

19 July 2019

After years of thumb-sucking, evasive behaviour and guestimates by people in government and other sectors of society, the Afrikaans Sunday paper Rapport recently reported that Dr Zweli Mkhize, Minister of Health, indicated that government will spend an additional R30 billion per year in future to implement the National Health Insurance (NHI) system.

Treasury recently gave startling facts to members of parliament about the state of affairs at the Department of Health. Some R600 million earmarked for NHI groundwork was not spent in the fourth quarter of last year. The first question that needs answering is how they intend to spend an additional R30 billion if they cannot even spend a fraction of this amount.

According to Mkhize, the money will be spent on prenatal care, chronic medicines and (pegged) tariffs for doctors who are obliged to service a certain number of people in a geographical area. At least now we have a vague idea of what the money will be spent on, even though we still don’t know what the apportionment will look like or if the annual R30 billion is correct and not just thumb-sucked.

The rub now lies in how and why this money will be spent, and clues of this may be found in what Mkhize did not say. Fixing up and building hospitals and buying new equipment weren’t even on his list, or are deemed not important enough for the Minister to mention. To be honest, it will take R30 billion and a whole lot more to even approximate the completion of this task.

Training more doctors and nurses – two professions that are seriously understaffed in South Africa – didn’t make Mkhize’s list either. Beeld recently reported that half of all registered nurses will retire in the next 15 years and there are not nearly enough young nurses to fill this growing gap. Emigration of health workers to developed countries due to demand for services rendered to ageing populations is another serious problem and one that’s been developing for the past two decades. Challenges – all caused by a toxic mixture of government’s incompetence, bureaucracy and bad policy – with accrediting qualified nurses and permitting the private sector to train staff are also partly to blame for this shortage. Even the private sector is struggling to fill vacancies. One could call it a crisis.

In relation to the mentioned and unmentioned spending priorities, it is safe to say that they merely reflect existing spending priorities undertaken by the state when it comes to health matters. There is nothing special about it. These are services and products that should be rendered regardless of a plan to implement the NHI. What is tragic, is how the current budgets are being spent and misspent and that these services are in many cases woefully inadequate to address the public’s needs. If the current state of public healthcare is taken as any serious measure, we are very far off from even approaching anything that resembles quality universal healthcare.

Mkhize also noted that 30 managers have now been dispatched to the United Kingdom, Japan, France and other European countries to learn how universal healthcare systems work. One would think that this would have been done by now and before Cabinet recently approved the NHI Bill of 2018 – thereby plunging us headlong into something the country is completely unprepared for.

And why look at these countries when the ANC’s lodestars for everything ideological have always been Cuba, the Soviet Union and, more recently, Venezuela? Wealthy Western countries – for whom the ANC has nothing but disdain – and Japan have now seemingly become the paragon on which the NHI will be modelled despite these countries (as well as Cuba) having completely different economic, demographic and disease profiles than South Africa.

Mkhize, his boss and their party have all resorted to fantasy and wishful thinking in the absence of the will to make tough decisions. South Africa’s healthcare system could be greatly improved by enforcing discipline at public institutions, improving accountability and standing up to the militant socialist unions that undermine the system and the public as its beneficiaries, as well as involving and deregulating the private sector to a far greater extent. This isn’t extremely difficult, but the ANC doesn’t seem to have the moral rectitude or political will to make the decisions that matter. Instead, they resort to diverting money away from other spending priorities or taxing us to the hilt to make this chimera a reality.

The NHI and the money being thrown at it are akin to palliative (and even life-threatening) care if the most basic and fundamental issues are not addressed. At long last the NHI got a nebulous number attached to it, but the cost of accelerated emigration among health professionals and taxpayers, increased taxation, a nationalised private healthcare sector and further government incompetence is yet to be calculated.

Dr Eugene Brink is Strategic Advisor for Community Affairs at AfriForum.