NHI: ‘Not enough’ financial resources, health professionals to provide medical care

South Africa may be staring down the barrel of a giant mess. Now that National Health Insurance (NHI) is fast becoming a reality, the healthcare sector is highly concerned, not just about the quality of future care, but the immense opportunity cost to the country. But that’s only half of it.

About NHI

This is what the NHI could mean for you, according to Mike van Wyk, chief executive of Medicare24, who wrote his master’s thesis on public health and the NHI:

• Salaries could be taxed with a levy by Sars, like Seta training charges, probably at least 1% if we are lucky. Then, VAT will be increased to 16% from the outset to fund what will likely become another albatross around taxpayers’ necks. NHI will become another Eskom, SAA and the several hundred cash-guzzling, corruption-infested, state-owned companies.
• Doctor and patient relationships will be wiped off the board. Under a NHI system, a giant call centre, with a R1 billion annual budget for itself, will allocate patients to healthcare providers within a 20km radius of their residence. Then comes the wait and patients “simply become numbers on a file, shared via a system, between doctors,” said Van Wyk.
• “Private medicine will be paid from your pocket because chances are medical funders would have to pay across day-today benefits, the savings plans we all know, to the NHI.”
• The NHI doesn’t end with government controlling who, when and where anyone gets to receive medical help. It will also control who, where and from whom patients are able to purchase scripted medication from.

“Hopping over to Dis-Chem or a local chemist to fill a script will not exist anymore. Wellness and pharma will be completely controlled by the state,” he said.

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Interestingly, all South Africans bar the military will be subject to NHI, its queues and its proposed control. And of course, said Van Wyk, the president and those in office will be exempt and have access to quick, easily accessible medical care.

“All sick people are equal,” he said, “but when it comes to the sniffles, the president’s men are more equal than others.”

‘Complex system’

Van Wyk pointed out that the medical sector was a complex system and, as the partial collapse of Britain’s National Health Service and the extreme waiting times for care in Canada has shown, universal access to healthcare is not working in its current form in most countries.

He likened the government NHI proposal to a festering wound borne from an infection at its genesis.

“It’s a fantastic idea, universal healthcare for all South Africans,” said Van Wyk, “but there are 40 million South Africans, limited financial resources and not enough professionals to provide the actual medical care. South Africa is staring down the barrel of a giant mess.”

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Opposition parties say that despite upfront denials from the ANC and government, the timing of the NHI smacks of electioneering.

Freedom Front Plus said in a statement this week: “The truth is that the NHI is nothing but a political gimmick that the ANC is using to canvass votes for the 2024 elections. It promises everyone everything but, in the end, there will be nothing left for anyone.”

Previously, Democratic Alliance leader John Steenhuisen said it was clear that government did not have the capacity to manage healthcare at present and that it was inconceivable NHI would address the health concerns of South Africa.

Previously, The Citizen reported on poor conditions at Edenvale Hospital and Tambo Memorial Hospital. The scandalous tender fraud at Tembisa Hospital is well-documented, along with a myriad reports of lacklustre care and shocking conditions at other state facilities.

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While government clearly did some homework, said Van Wyk, the NHI’s paper plan is simply not practical and role players were not adequately consulted.

‘Short-sighted’

The Hospital Association of South Africa echoed this in a statement yesterday.

It said: “To summarily ignore the many who voiced their concerns regarding governance structures and operational efficiency concerns, the concentration of risk in a single-payer system in an unstable economy featuring endemic corruption, and the many other concerns raised by state attorneys, is short-sighted and highly unwise.”

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The association’s concerns echoed that of Medicare24.

“Passing such vast, complicated, risky and consequential legislation requires confidence, trust and stakeholder collaboration. The approach taken undermines confidence and poses a threat to trust.”

Van Wyk felt trust had already been eroded.

“We saw that during Covid, the government struggled to cope, mismanaged much of the interventions and the high quotient of corruption that the pandemic delivered is surely a foreshadowing of what’s to come under the NHI.”

The association has urged government to consider a multiplayer model which will decentralise control from government.

– news@citizen.co.za