Many South Africans have seen the term ‘NHI’ in the news and wonder what it means. The NHI stands for National Health Insurance. This article will try give some explanations about what the proposed National Health Insurance system is and how it will affect South Africans.
What is the NHI?
The National Health Insurance (NHI) is a proposed financing system whose stated purpose is to give all citizens and legal long-term residents of South Africa essential healthcare, regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund.
“It will not be an exaggeration to say that the NHI is the ‘land question’ of health. In the same way the land issue is raging all over the country, NHI is going to rage in a similar way, not only in the field of health but in the economic and social lives of our people,” Health Minister Aaron Motsoaledi said in a speech to the National Council of Provinces on Tuesday 19 June 2018.
“Under NHI, the rich will subsidise the poor. The young will subsidise the old. The healthy will subsidise the sick. The urban will subsidise the rural,” Motsoaledi added.
Who wants to implement the NHI?
The South African Department of Health wants to implement the National Health Insurance system.
Government argues that healthcare being a human right is a widely accepted international principle and the right to obtain healthcare is written into South Africa’s Constitution. Government also argues that without the NHI the majority of the country’s population will not access good quality healthcare.
Above: Google searches on the topic ‘National Health Insurance’
What conditions will the NHI cover?
The National Health Insurance White Paper gives a long list of the services the NHI is to provide free of charge to all South Africans. These include cardiology, dermatology, neurology, oncology, cancer treatments, psychiatry, obstetrics, paediatrics, gynaecology, orthopaedics, and surgery.
At the primary health care level, the services provided will include ‘sexual and reproductive’ health care, optometry, ‘oral health rehabilitation’, remedies for mental conditions and disability treatment. Treatment for ‘rare diseases’ and ‘dread diseases’ will also be provided, along with some radiology services.
How much will the NHI cost?
In the white paper, the projected NHI expenditure in 2025 (when the system is supposed to be operational) will be around R256 billion in 2010 prices.
Criticisms of the National Health Insurance
Dr Anthea Jeffery, Head of Policy Research at the IRR, argues that long waiting times for medical treatment will become even longer, putting lives at risk. Poor citizens will bear the main brunt of this, but the middle class will also have to wait months for medical appointments and treatment.
The NHI may cause health professionals to emigrate
Jeffery claims that the NHI Fund will be responsible for reimbursing all doctors and other healthcare professionals for the medical treatment they have provided to patients free of charge. But the Fund is unlikely to be any more efficient than other state bureaucracies operating in South Africa. So doctors could wait months or years for their payment. This too could encourage a major exodus among the country’s health professionals.
The NHI will do little to address often poor standards in public health care
The Institute of Race Relations argues thatthe problem is not simply high demand, but rather bad management in public hospitals, clinics, and provincial health departments.
One example of this bad management is the R500 million Xhariep District Hospital in Trompsburg in the Free State. Although the hospital was completed in 2013, it still remains unstaffed and unused.
Additionally, late payments and inefficient administration make for persistent shortages of medicine and there is poor maintenance of essential infrastructure and equipment. These factors, combined with poor hygiene and uncaring staff attitudes, contribute to unnecessary deaths and mounting medical negligence claims – and help explain why only 16% of public hospitals and clinics in the country currently comply with the basic healthcare standards to qualify for NHI participation.
The NHI will end the efficient private health care system in South Africa
Online, some argue that if the NHI was implemented, the brain drain, economic collapse and pure misery that this kind of social engineering is going to bring will condemn South Africa to developing country status for generations to come. Some senior medical specialists have apparently said that they will either leave or close their practices if these changes come to fruition in the next few years.
The IRR argues that the proposed NHI with its flawed assumptions and false promises should be abandoned.
The Free Market Foundation claims that the NHI scheme concentrates power in the hands of the government, which is acting as both a player and referee, leaving no room for the private sector to operate.
They go on to add that “Under the NHI, whether directly or indirectly, the government will control the availability, financing and delivery of healthcare from the cradle to the grave and South Africans will no longer have any choice.”
What are some alternatives to the NHI?
The Free Market Foundation argues that the government’s role should be to finance healthcare for the poor and leave the private market alone to provide for those able to fund their own healthcare. This will allow government to concentrate scarce taxpayer resources on the truly destitute, while allowing the private sector to grow, innovate and expand.
The IRR makes the case that the government should use public-private partnerships to overcome poor management in the public sphere. It should also make it compulsory for all those with formal jobs to join a low-cost medical scheme, and take out low-cost medical insurance against funding shortfalls and adverse changes in health status. In addition, it should use tax-funded health vouchers to extend similar cover to the unemployed and economically inactive. Combined with other reforms, these proposals would provide South Africans with universal health coverage in an efficient, affordable, and sustainable way.
Where can I find out more about the NHI?
Below are some additional resources on the National Healthcare Insurance policy.
- Submission on National Health Insurance Implementation Structures
- Health insurance disappears for South Africans
- Government’s programmes will violate right to access healthcare
- Mismanagement will ultimately scupper the National Health Insurance (NHI)
- Government’s NHI plan is based on squeezing out private healthcare
- IRR Submission to High Level Panel on Proposed National Health Insurance (NHI)
- SA’s proposed National Health Insurance system will fail – IRR
- Criticism of National Health Insurance in South Africa