Experts warn that South Africa’s NHI plan has a major flaw: it’s not going to work
Health, governance and legal experts have warned that the planned introduction of the National Health Insurance (NHI) won’t achieve universal healthcare coverage in South Africa as envisaged by the government.
In a webinar hosted by think-tank the Free Market Foundation, the group warned that the NHI will not deliver improved health outcomes for the majority of citizens, and will also damage some of the existing systems put in place by the private healthcare sector.
Professor Alex van den Heever, chair in the field of Social Security Systems Administration and Management Studies at the Wits School of Governance, said that the NHI has been abstracted from the reality of South Africa’s health system.
He said that the proposal lacks feasibility on two fronts.
“First, the financing assumptions are nonsense and suggest that the proposers have no understanding of basic public finance principles.
“Second, the institutional approach assumes that we can sweep away both our public and private systems and implement a third, untested system.”
When both these features are considered, the capabilities of state to take forward the NHI are not equal to the task it has given itself, said Van den Heever.
It also suggests that government does not understand the health system problems South Africa is facing. As a consequence, the necessary reforms will never happen, he said.
“The necessary reforms do not require a reconfigured health systems architecture. In the public sector we require a revised governance framework which properly separates the executive of government from the delivery of services.
“In the private sector we need to begin addressing the reform framework proposed by the Health Market Inquiry. However, it appears as though the top health policymakers are permanently distracted by graft rather than addressing appropriate health reform.”
Van den Heever said there is presently a severe lack of leadership that undermines the ability of the state to take forward even the most basic health reforms.
“Until this is addressed we will constantly be peppered with phoney reforms that will never see the light of day and a health system that is incrementally in decline.”
Legal concern
Patrick Bracher, director at law firm Norton Rose Fulbright, further argued that the NHI Bill is inconsistent with the Constitution.
“The hope of everyone should be that the government recognises the impossibility of implementing the NHI Bill and fulfils its primary undertaking to strengthen the existing healthcare system.
“There are already sufficient structures and resources which, properly governed, will fulfil the worthy promise in the preamble to the Bill to enable everyone to access the highest attainable standards of healthcare services based on social solidarity.”
Poor track record
Free Market Foundation deputy director Chris Hattingh said that there is no good reason to believe that the NHI will outperform the country’s other state-owned enterprises.
“Centralising the management of all healthcare in South Africa in the hands of the state, as the NHI would require, will not achieve better universal health coverage, especially not for indigent citizens,” he said.
This was echoed by the foundation’s Michael Settas who said that there is a clear disconnect between reality and what government is feeding the public regarding NHI.
“Our analysis of resources in the public sector showed a doubling in real, per capita health expenditure over the past 20 years and an increase in public sector medical personnel of 42%.
“An international analysis put our public sector expenditure levels higher than many richer developing countries, whereas our outcomes lagged near the bottom,” he said.
“The sad reality for the country’s citizens, is that it is the spectre of endemic corruption, maladministration, institutionalised cadre deployment and widespread governance failures that have stripped the public sector of its capacity to deliver quality healthcare.”
Read: Medical aids in the firing line amid calls for all reserves and assets to be handed to the NHI
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