Why the haste with NHI?
11 December 2019
Will someone in government explain to us why it insists on shooting itself in the foot, not occasionally but consistently and repeatedly?
The government constantly sets hopelessly unachievable targets, as with the National Health Insurance (NHI) scheme. It is supposed to come into operation in 2026 but has not even been costed. Sceptical observers say it is unaffordable by a government that has run out of our money, with hospitals that are so far below par as to be a blot on our national reputation and with a shortage of nurses estimated to total 40 000 by 2025.
Far worse, however is the news that the government is rushing ahead and proposing that by 2021, barely a year away, the hospital insurance enjoyed by upwards of two million low income people will become illegal. Instead of being able to receive treatment at private hospitals, these patients will be required to go to the already over-crowded, overloaded, understaffed and under-funded state hospitals. This decision has been taken by the government appointed Council for Medical Schemes (CMS), the members of which are appointed by the minister of Health. Their decisions presumable carry his enthusiastic approval. And for what end? The answer seems to be to pave the way, five years in advance, for the introduction of the NHI.
Riana de Lange, writing in Rapport, stated that the executive head of the CMS, Dr Sipho Kabane wrote in a circular that the low-cost project and the existing low-cost products (offered, for example by Discovery as the Primary Care Plan and by Momentum as Domestic Care) would undermine NHI, which was official government policy. He also accused certain plans of exploitation. This arbitrary and shockingly sudden decision will have the effect of bringing to an end the imaginative scheme in terms of which the medical aids have spent ten years working towards providing affordable cover for 8million low income households. The proposals for the extension of the low-cost scheme will now be junked despite the fact that cover could have been acquired by households earning less than R16 000 per month and even R6 000.00 per month at a cost of between R828.00 and R1 647.00 for a whole family.
All of this goes to the heart of the ideological dreamworld in which the government operates. They still believe that government can do everything; should do everything; and will do everything, despite every bit of evidence to the contrary. It would be great if South Africa could have a health system like that of the UK. National Health suffers from a perennial shortage of nurses and doctors and it has to recruit people from all over the world to staff its hospitals. But the UK is a rich country; it is not nearly broke like South Africa is at present. The NH cost for 2019/2020 is estimated at 134 bn pounds sterling. That translates into around R2.5 trillion, whereas our total tax revenue for 2019/2020 was projected (but later revised downwards) at R1.3 trillion.
Most sensible people – and compassionate people – will agree that all South Africans should have access to medical care of a reasonable quality. Those who are well-off should be permitted to get on with paying whatever is required for their quality care; people of more modest means should have schemes proving affordable health care; and the poor, the millions who cannot afford it, should have access to state hospitals that make us proud. Government should be busting a gut to improve the standards of our hospitals so that our people get the care they deserve. Forget ideology and focus on the sick; that should be the aim.
Douglas Gibson is a former opposition chief whip and a former ambassador to Thailand. His website is: douglasgibsonsouthafrica.com
*This article first appeared in The Star
