Arguments for and against NHI

Since the National Health Insurance (NHI) Bill was introduced to Parliament last week, the debate about the plan which promises to fundamentally change healthcare in South Africa has heated up.

While the arguments for NHI tend to focus on the massive inequalities in the current access South Africans have to quality healthcare, the arguments against NHI tend to revolve around the practicalities of its implementation and an ideological aversion to state interventions.

The argument for NHI:

Quality healthcare for all

Currently, 84% of South Africans are dependent on the state’s health services, while the remaining 16% – who can afford it or can afford medical aid schemes – make use of private medical care. However, skilled professionals follow the financial resources, and according to the Department of Health, 80% of medical specialists in the country are in the private sector. Furthermore, South Africa is spending 4.4% of the GDP on only 16% of the population’s health services, and only 4.1% for 84% of the population.

The aim of NHI – and the main argument in its favour – is to address this inequality.

NHI will create a single pool of healthcare funding for private and public healthcare providers. The NHI Fund will pay public and private healthcare providers on the same basis and expect the same standard of care from both. This would allow people in lower-income groups to consult doctors in private practice and use private hospitals, with NHI picking up the bill. This will spread the burden of care more equally across the private and public sectors.

For some of its supporters, NHI is the only plan that can achieve this.

The arguments against NHI:

The state can’t afford it or taxes will need to pay for it.

Critics question the state’s ability to fund NHI – which will have mammoth costs – and fears that the taxpayer will be further burdened.

Creating another state entity – the opportunity for more looting.

To run NHI, another state-owned entity will need to be created. Given the revelations of grand-scale looting at state-owned enterprises like Eskom, the fear is that NHI will be another opportunity for robber barons to make off with public money as their loot at the expense of ordinary South Africans.

Job losses and the brain drain.

In February, BusinessDay reported that the Hospital Association of SA (Hasa) said the implementation of NHI could lead to 132 000 job losses. There is also the notion that specialists and other medical personnel might leave for greener shores where NHI will not cramp their style.

It will not fix the already strained public healthcare system.

There are almost daily stories in the media about the inefficiencies of the public health system – sometimes with ghastly details. Some critics argue that the existing problems in public healthcare should first be fixed and the service expanded before an ambitious project to achieve universal healthcare is implemented.

It takes away an individual’s choice.

Some critics object to the state prescribing which health institutions people will have to use.

Economic impact

According to some critics, NHI will hurt the private health sector and medical aid schemes and that this will have a further impact on the South African economy as a whole.

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