The Institute of Race Relations (IRR) says that while the South African government’s push to implement a policy of National Health Insurance (NHI) to ensure that every citizen has decent healthcare is a noble goal, it is unlikely to become a reality.
President Cyril Ramaphosa said recently that the NHI would begin in a phased approach from 2019, with all South Africans to be covered by 2025.
All South Africans will be compelled to belong to the NHI system, without the right to opt out. At the same time, people will have to pay into the system even if they choose to pay contributions to a medical aid, too, said the IRR.
All health revenues will be paid into a central fund, from which all health disbursements will be paid. The state will decide on all aspects of health-care, and private healthcare will effectively have been nationalised, with all that that entails, it said.
“The South African government has shown itself to be poor at running a wide range of entities, from South African Airways (SAA) and Eskom to the education system – the list is long – and there is no reason to think it will manage to run the entire healthcare system effectively,” the report said.
The NHI will have serious consequences for medical aids and for individuals.
Medical schemes will only be allowed to provide ‘complementary cover’. In the long term, all medical aid schemes will likely cease to exist. Few individuals will be able to afford medical aid on top of the increased taxes that they will have to pay to help fund NHI. Most people will be forced to rely on government healthcare, the IRR said.
In its latest report, ‘South Africa’s National “Death” Insurance Scheme’, it points to what it says is the “appalling scale of deficiency, mismanagement, negligence and corruption in the public health sector” which, it added, the government intends to be the core of its proposed healthcare system.
The report argues that while the avowed goal of NHI in ensuring that every South African has decent healthcare is a noble one, it is unlikely that the government will be able to make this a reality.
It said that the problems run deep and come at a high cost to South Africans.
The bulk of the report is devoted to a collation of more than 100 media reports on negligence, corruption, and mismanagement in our public health sector between April 2017 and August 2018.
Authors Marius Roodt and Mailies Fleming write: “Some incidents, such as the Life Esidimeni tragedy – which saw more than 100 people die because of government mismanagement of the public healthcare system – are well known.
“But this shameful episode is matched by many other incidents in which, due to negligence, mismanagement, or corruption, people received sub-standard medical care and, in extreme cases, were disabled or even lost their lives.”
Many of these incidents, the report’s authors said, have not received widespread coverage – and it is possible that yet more incidents have not been reported on at all.
The list, they said, ‘reflects a healthcare system in crisis’.
Examples of the crisis highlighted in media reports since August last year include:
- A 13-year-old boy losing both feet, his left hand, and four fingers on his right hand following complications after appendix surgery. He was not taken to a high-care ward after his operation as the lift was not working. The amputations followed an infection that affected his circulation;
- Patient files being stored in a space too small to accommodate them and often being damaged by damp when it rained;
- A botched birth which resulted in a baby suffering from quadriplegic cerebral palsy;
- A woman having to return to hospital a week after her caesarean section because of abdominal pain; it turned out a swab had been left in her abdomen, and her placenta had not been removed;
- A toddler being left brain damaged allegedly because of the slow response of nursing staff to her choking on her own vomit after intestinal surgery;
- A study of health standards finding that only five out of the 696 hospitals and clinics inspected complied with the standards set out by the Department of Health in order to achieve an 80% pass mark;
- A baby losing an arm after an intravenous drip had been incorrectly inserted, leading to complications and, ultimately, amputation;
- One woman having her bladder stitched to her womb during a caesarean operation – but the doctors not being held to account because vital information was missing from her file;
- The revelation that there is not a single full-time oncologist working at any of KwaZulu-Natal’s state hospitals;
- A man being discharged despite a part of an ankle wound still being open. He required further surgery four months later, and will likely have to wear an ankle brace for the rest of his life;
- A staff nurse mistreating a bedridden patient, ridiculing her for being unable to sit up to have her diaper changed and not drawing the bed curtains to give the woman privacy. The patient died the following day, reportedly receiving ‘very little assistance’; and
- The unexplained discovery of a 61-year-old man’s body in a hospital ceiling 13 days after he disappeared following an operation.
The IRR argued that continuing to fund the country’s deficient public health system and effectively nationalising private healthcare will not improve health outcomes.
“South Africa needs to be innovative in working to provide quality healthcare for all, but disabling excellence in the private healthcare system will not be the answer,” it said.
“Greater access to private healthcare should go hand in hand with improving the public healthcare system, which can only be achieved through merit-based appointments, strict accountability for poor performance, and effective action against corruption and wasteful spending.
“Access to private healthcare can be expanded by allowing low-cost medical schemes and primary health insurance policies.”
The IRR said that poor households should be helped to join these schemes or buy these policies through tax-funded health vouchers.
To help spread risks, medical scheme membership and/or health insurance cover should be mandatory for all employees, with premiums for lower-paid employees buttressed by employer contributions for which businesses would garner tax credits.
“Medical schemes and health insurers would then have to compete for the custom of South Africans, which would encourage innovation and help to hold down costs,” the IRR said.
The report recommends increased public-private partnerships, regulations to allow the private sector to establish more day hospitals and the like, and that private universities and hospitals be permitted to train doctors, specialists, and other health providers, as public training institutions cannot meet the scale of need.
The full report is embedded below: