Michael Settas, Health Policy Unit, Free Market Foundation – 20 February 2019
Election season is here and this past week we have heard about the ruling party’s grandiose National Health Insurance (NHI) proposal and its new springboard, the report by the Presidency on last year’s Presidential Health Summit.
NHI has every potential to lead SA into peril with its far-reaching consequences and unprecedented magnitude. The draft NHI Bill, that will shortly be presented again to cabinet, proposes to create a monolithic single-payer fund that will be the sole purchaser of statutory NHI healthcare benefits in SA.
NHI will undoubtedly be the largest SOE in the country, with an estimated current budget of more than R400bn annually – more than double the existing public health budget. The NHI Fund will be akin to one massive medical scheme for the whole country. So enter another government monopoly, setting prices, throttling supply and dictating who can deliver healthcare. It will nationalise the private sector, eradicate medical schemes and be the sole custodian of how, when, or what healthcare citizens will receive.
In speech after speech by the President or the Minister of Health we are told SA must implement NHI to attain the laudable goal of universal health coverage (UHC). The only latent problem with this intent is that we already have a health system capable of delivering UHC – the World Health Organisation has accorded SA a UHC score of 0.67 (1 being perfect and 0 non-existent). But the inept management of public healthcare facilities renders the system prostrate, meaning that government fails to meet on the promise of UHC.
A 2018 inspection report of clinical compliance shows that the Office of Health Standards Compliance (OHSC), an independent statutory body within the Department of Health, accorded an 80% pass mark to a mere 1% of public facilities it inspected. On the opposite end of their accreditation scale, 26% of facilities were scored as being ‘Critically Non-Compliant’, 36% as ‘Non-Compliant’ and 23% as ‘Conditionally Compliant with Serious Concerns’. This means that 85% of these facilities are not meeting basic standards of care.
Through the OHSC, government has admitted that it is not even remotely capable of delivering decent healthcare services. But the Minister of Health and the President, now through his Presidential Health Summit, obfuscate the whole sorry mess with the promise of NHI. The President talks of a ‘war room’ that has been set up within the Presidency to fix the public health system but sadly there is no focus on how to improve delivery and get 85% of facilities to pass the OHSC accreditation. The ‘war room’ has a sole focus – building NHI – as if it will be a magical panacea for all public sector woes. The Minister of Health perpetually berates the private sector as being too expensive and then, without even a hint of appreciation of his own contradiction, declares that with more than R400bn of NHI funding he can fix the problems in his department.
The 2018 OHSC inspection report describes the issues at hand – mostly relating to poor management, a lack of critical skills, logistical failures, medicine shortages, poor hygiene – the list continues. What is obviously apparent to even the most casual reader, is that more money will not fix these issues. But government is obtuse on this point – it thinks that by nationalising the private sector and introducing NHI, it will provide a workable and sustainable healthcare system to rectify these problems.
The state of public healthcare can be described as nothing short of a national disgrace! It is the poorest and most vulnerable that suffer when healthcare isn’t provided. Think of the horrific Life Esidimeni tragedy, where more than 140 people died needlessly through neglect, some even from starvation. Yet these are the very people, society’s most vulnerable, that government declares it is now going to look after properly by introducing NHI.
Such empty promises are juxtaposed against a track record of utter disdain for effective public service administration that reflect neither accountability nor consequence for incumbent bureaucrats.
The vast implications of the NHI proposals are not benign and have all the attributes to make the Eskom saga pale into insignificance by comparison!