NHI: A Debate Beyond Slogans, Facts Needed to Guide Healthcare Policy
Minister Motsoaledi has been telling the entire country that the National Health Insurance (NHI) is a recommendation of the World Health Organization (WHO). This assertion is based on the belief that NHI equals Universal Health Coverage (UHC). However, this is misleading. NHI is just one of several pathways countries can take to achieve UHC. Specifically, NHI operates as a single-payer system—a large-scale insurance program managed by the government. It's important to note that UHC can be achieved through either single-payer or multipayer systems.
Many countries achieve universal health coverage without employing a single-payer system. Germany provides a prime example of this approach. In Germany, universal healthcare is maintained through a multi-payer system funded by a combination of statutory health insurance (Gesetzliche Krankenversicherung) and private health insurance (Private Krankenversicherung). This system integrates free market principles with socialist healthcare elements, showcasing its innovative design.
German citizens who earn above a specified income threshold or are self-employed have to enroll in to private health insurance (PHI). Those earning below this threshold contribute to statutory health insurance (SHI), which comprises non-profit insurance funds known as "sickness funds" that compete with each other. This setup fosters competition and consumer choice.
Germany boasts one of Europe's most unrestricted and consumer-oriented healthcare systems. It is widely recognized as one of the world's best healthcare systems, characterized by substantial cash reserves and efficient service delivery.
Germany spends less than half of what the USA spends per capita on healthcare yet achieves superior health outcomes. Life expectancy in Germany exceeds that of the US by 2.5 years. Germany has successfully implemented universal healthcare coverage while preserving competitive insurance markets that provide citizens with greater choice. They ensure coverage for 100% of the population.
In contrast, consider the National Health Service (NHS), a single-payer system from the UK that many people have criticized as a disaster. According to the British Treasury, the return on investment in the NHS has been poor, despite substantial funding increases. The UK spends more on healthcare than similar countries, yet it has fewer hospital beds and diagnostic tools, and nurses receive lower pay.
The laundry list of problems includes:
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South Africans cannot afford another Eskom-like situation in the name of NHI that takes away their freedom to choose. We can achieve Universal Healthcare Coverage that functions effectively. This national health insurance is unaffordable, which is why our politicians are attempting to counter facts with emotions.
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