The Democratic Alliance (DA) calls on Minister of Health Dr. Aaron Motsoaledi to provide the full details of the National Health Insurance (NHI) programme to the public right away, or, if he is unable to, to withdraw this proposal until the details can be properly laid out.
The ANC's Health Committee spokesperson Dr. Zweli Mkhize released some details of the programme yesterday. The details, however, remain very vague, and although we have now been presented with some funding details, the actual specifics of the programme remain obscure.
In addition, the Portfolio Committees on Health and Finance need to be brought into the process of formulating and costing these proposals. Parliamentarians, independent researchers, non-government organisations and ordinary citizens have a right to gain sight of the specifics of the proposals, and debate them. In the absence of this, we are faced with a situation where a potential major overhaul of the public health system is being done behind closed doors, in a fundamentally undemocratic and non transparent manner.
We are particularly concerned at the financing calculations which the task team has produced. A variety of other organisations have produced calculations indicating much higher costs, and countries which have three times South Africa's GDP have struggled with the finances of implementing the kind of system that appears to be on the table. The fact that the proposal, up until this point, has been fundamentally hidden from public view, makes the funding issue particularly concerning. The ANC says it is considering raising VAT to fund the NHI - this is a move that would disproportionately impact upon the poorest South Africans, because of the regressive nature of that tax. The ANC also says it is considering raising the funds through payroll taxes, which could push up unemployment. Any programme of this kind is bound to come at a cost, but the fact that the ANC has refrained from presenting their plans to the public means that it is impossible to engage in any of kind of proper debate about the nature of the opportunity costs involved - particularly in respect of job creation and general societal welfare.
It is also important to bear in mind that the government does not even have accurate figures on how many specialists there are working in the public sector, or what the cost is of the individual services it provides. Until a system exists for determining these kinds of figures, it is hard to obtain any idea about the accuracy of the ANC's calculations.
We agree with the ANC that reform of the public health system is urgently needed. The present system is collapsing. But any attempt at reform must be done without resorting to the creation of the sort of cumbersome centrally-controlled bureaucratic structures. All the evidence points to three central problems in our health care system:
Firstly, we need to remove the inexplicable constraints on the training of medical professionals, of which we are desperately short. These include the removal of a prohibition on training doctors in the private sector and quotas on the training of nurses by the private sector and the re-opening of nursing colleges closed in the 1990s.
Secondly, at ground level major problems continue to exist with the capacity and efficiency of hospitals, and their managers in particular. The problem is not necessarily related to funding; if every hospital were staffed with a well-trained, experienced and committed CEO, then we could make enormous inroads into resolving our major public health care problems. All too often, as was the case in the Frere Hospital scandal, it is the appointment of hospital managers based on patronage rather than fitness for purpose that is holding back the provision of quality health care services in public institutions.
Thirdly, our bureaucratic and outdated hospital management system needs to be changed to give hospital management the authority to do their jobs. Basic functions like making staff appointments need to involve far less red tape.
The DA supports some aspects of the proposals. We support mandatory contributions towards medical cover for people who are employed, because everybody has a responsibility to take charge of their own health, and because this would help to alleviate the pressure on the public sector. This does not change the fact that until the full details of the proposal are released to public scrutiny, and the financing models are properly assessed - in Parliament, by the people's representatives - we are no nearer to resolving our public healthcare crisis.
Statement issued by Mike Waters, MP, Democratic Alliance shadow minister of health, September 22 2010
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