NHI unhealthy for SA in current form, say experts

The National Health Insurance (NHI) Bill passed by the National Assembly last week has caused alarm among healthcare providers, medical aids, and political analysts, who say that in its current format, it could cause a deterioration in standards and prompt a mass exit of skilled professionals.

A Jewish doctor, who works as a specialist in both the government and private healthcare sector, and who chose to remain anonymous, says though there’s a lack of clarity on how the NHI will affect doctors especially those in private practice, they have significant concerns.

“You see the mismanagement, corruption, and infrastructure challenges when you work in state. Why break the private system to try and patch the broken state one instead of trying to fix it? That would be much more to the point.”

For specialists, government income is often insufficient, the specialist says. “With our current economic situation, I need to supplement this income with private work. Yet that concerns me less than access to quality healthcare in this country. If you break the private system, you create a huge burden on an already broken public system. I don’t think it can cope.”

Dr Frans Cronje, a renowned political analyst and the director of think tank, the Social Research Foundation, said we underestimate the seriousness of the Bill at our peril. Cronje was talking to Chief Rabbi Dr Warren Goldstein in a webinar hosted on 19 June. “If the policy is eventually implemented as currently drafted, it will cause immense damage to South Africa because you cannot sustain a middle class in the absence of world-class healthcare,” he said. The middle class will then exit, causing a skills and capital shortage.

Steven Crouse, the chief investment officer and senior wealth navigator at independent financial solutions company Octagon Financial, also warns of a brain drain, specifically among private doctors. “I have friends who are medical professionals who have emigrated years ago under the threat of NHI,” he says.

“Unfortunately, more will likely go that route, but can they live elsewhere like they live here? Probably not. Wherever else they go, they’ll be entering a public healthcare system.”

Though the NHI itself will reportedly not be modelled on any one country’s system, Health Minister Dr Joe Phaahla recently paid a fact-finding visit to the United Kingdom (UK).

Renee Snoyman, who recently returned from four years living in the UK where she was a care worker for the elderly, says that public healthcare systems like that country’s National Health Service (NHS) are far from ideal. It takes ages to see a general practitioner, she says, who needs to be consulted before you can get a repeat script for vital medication.

“I once went to the hospital with one of my customers who had Parkinson’s and had broken her hip,” Snoyman says. “It was full, so we sat in the corridor with hundreds of other people the whole day. They didn’t have space, and she needed the operation, so she was on a waiting list either to be put into the main ward or transferred to another hospital. And this is a first-world country that’s had the NHS for many years.”

Yet, says Crouse, the NHI isn’t financially viable, especially in an economy where growth is already severely constrained. “In the past six budgets that have been passed, there hasn’t been a single cent allocated towards NHI,” he says. “And there has to be.

“The African National Congress [ANC] is telling people what they want to hear as it approaches the 2024 elections,” he says. “This is very much a vote-attracting mechanism. But on the ground, there’s been nothing. And that’s why I’m not, at this stage, panicking. Couple that with the question of whether the ANC is ever going to be in a position to raise taxes – it can’t squeeze juice from a lemon that’s been squeezed dry already.”

Though Crouse believes there’s no need for panic, he says we need to get our minds around some form of redistributive healthcare. “But I don’t think it will be the one that says you’ll be forced to go here or there, because supply and demand and market forces will take care of that. Those with much bigger and deeper pockets, who fund our government, will ultimately have a say in it, especially if it’s going to bankrupt this economy and if it’s going to be open to looting, a real risk.”

“If the current proposal is implemented, the state will ultimately be the single point that purchases all healthcare services in the country,” says Cronje. The Bill aims eventually to nationalise private medical schemes and incorporate their resources into a single pot of funds from which those healthcare products or services will be made available.

“Regardless of who you are or where you find yourself in the country, you will be able to, in theory, visit any care provider who will provide care services to you for free and then claim back from the state.” Yet we are a very long way away from any form of implementation, he said.

The Bill is founded on the idea of a single-payer model, and makes no allowance for private medical aids once fully implemented. In a press release issued in response to the adoption of the Bill, Dr Ryan Noach, the chief executive of Discovery Health, stressed the need for better integration of private healthcare as opposed to its disbandment.

“Discovery Health remains committed to supporting the development of a National Health Insurance system and universal healthcare coverage that improves the equity and access to healthcare for all South Africans,” he says. “However, we don’t endorse the single-funder model as proposed in the Bill, and believe that sustainability can be achieved only through collaborative work between the private and public sector, built on the strength of the COVID-19 partnerships that served South Africa so well.

“It’s particularly concerning that the inputs of the healthcare professionals, who are core and essential to the delivery of care, aren’t being given the appropriate weight and attention in the amendments to the Bill,” Noach says.

In fact, the South African Medical Association (SAMA), which represents more than 12 000 doctors, has stated its opposition to the current version of the Bill. Detailing its objections, SAMA launched a Change.org petition which in five days, reached 47 000 signatures and counting.

This kind of active opposition is key to preventing the Bill’s implementation. “I expect that the body of resistance will continue to build,” Cronje said. “In that event, I expect we’ll see off this threat over the next three to four years, and replace it with much more constructive body of healthcare policy.”