“The majority of health care systems around the world are designed for the rich… not for the poor,” he said at the Steve Biko Centre for Bioethics at the University of the Witwatersrand.
“Something is missing. Unless we deal with health systems funding, nothing will happen.”
While the details of funding the NHI were up to Finance Minister Pravin Gordhan, the system would work on the basis of mandatory pre-payment for the whole population, he said.
Health care faced significant problems globally, including rising costs and poor access to generic medication, an overemphasis on cure instead of prevention, and insufficient regulatory control.
These factors threatened sub-Saharan Africa’s ability to achieve the United Nations health-related Millennium Development Goals by 2015.
The NHI was one interpretation of universal health coverage, a concept developed in the wake of the Second World War.
Universal health coverage aimed to provide every citizen with access to affordable health care, irrespective of a person’s socio-economic conditions.
“You don’t come up with universal health care because you are rich. You need it because there are problems,” Motsoaledi said.
When the United Kingdom began its National Health Service just after the Second World War, the country was poor.
Yet now, even the rich and famous made use of the UK’s public health system. This was in contrast to the situation in South Africa, where those who could afford private health care had developed an over-reliance on it.
Motsoaledi recalled a conversation he had with a reporter in 2009 when admitting his son to a government hospital. The reporter had asked him why he was not using a private hospital when he could presumably afford it.
“Then I thought, [the reporter] she is in her 30s. She has never seen public hospitals working. [Frequently] when African leaders are sick, they leave their people and go to Europe. We also deserve health care systems,” he said.
Motsoaledi said that he recently visited Qatar, which was developing its own version of universal health care. Building of this system began in July and would be completed in 18 months, but planning for it began in 1991.
South Africa’s NHI was expected to take 14 years before it was fully implemented because it faced problems including infrastructure, staffing, and water supply.