Part2: When proposed National Health Insurance is guided by ideology rather than proper planning.

Introduction

These past weeks various organisations presented to the Portfolio Committee of Health on their views of the proposed NHI. Almost all organisations that presented agreed with the NHI’s noble end goal, however they found various flaws within the Bill that will not only destroy what is left of our healthcare system and shrinking economy, but it will leave South Africans with no freedom of choice when it comes to healthcare services. Patients will either need to accept the poor quality of services or they need to form part of the 1%, to be able seek medical attention abroad, just like South Africa's Deputy President, Mr. David Mabuza. The NHI will remove ones freedom of choice, steal what is left of the countries shrinking income, and if not monitored properly, political elites could use it to enrich themselves. The NHI will be last cash cow that breaks the camel’s back, and this is why:

Putting Ideology First, Rationality Second

Firstly, the ruling is prioritising their ideology when it comes to health policy, while putting patient's health interests second. They seek to make sure the NHI Bill passes, no matter the cost to the country’s economy and its citizens health. They will do this by putting in little planning, budgeting and research into the policy from the beginning. To date, no adequate pilot studies have been done in order to test the efficiency of the bill on a small scale. UCT made this very clear during their submission to the portfolio committee. The university stated that very few features of the NHI were included in the pilot studies and therefore no conclusion can be drawn on the bills potential successes or failures. This means that something as consequential as an NHI Bill has not been experimented, with regards to implementation on a small scale. The way the NHI is structured leaves no room for a parallel healthcare system and completely takes over private healthcare. No other NHI system possess the exact same structure of this Bill, except for Cuba.

Refusing to Provide Adequate Costing for the Bill

Second, the ruling party has, for all intents and purposes, "thumb sucked" the cost of the NHI, having no real, adequate and updated costing. The actual cost for taxpayers of this Bill is a mystery, with no clear indication of financial sustainability. In 2017, NHI White Paper estimated that the cost of the scheme will be R256 billion per year at its estimated launch at the time, 2025. In a report by Institute of Race Relations, the real cost of the NHI is much higher and would most likely cost around R700 billion when fully operational. This poses a major concern considering that the country is experiencing a shrinking tax base compared to increasing state dependents relying on grants. The country has experienced acute growth in the amount of grants it hands down from 9?421?654 in 2004, with a population size of 46?584?607 (14%) to 18?290?592 2019/2020 with a population size of 59?622?350 (31%). According to SARS, in 2019, 6.3 million people paid tax. It does not take a rocket scientist to understand that the math just does not add up.

Additionally, the Bill and its "thumb-sucked" costing was created in a pre-covid environment whereby the country had completely different economic growth prospects. This means that the Bill is outdated and policy makers must go back to the drawing board. It's successful implementation relies on proper planning and costing. This is crucial if we are really to achieve universal healthcare.

Further Exacerbate the Inequality Gap with Health Access Between the Rich and Poor

There is a concern that the ruling party will ignore public participation inputs and valid recommendations from various organisations all in the name of “equality”. This is ironic, because the way the Bill is structured, it will further marginalise the poor and create a much larger health gap between urban and rural areas.

The Office of Health Standards Compliance (OHSC) is an entity who’s mandate is to monitor and enforce compliance with health establishments with?the prescribed norms and standards. This year, their goal was to review 8% of public facilities. This number is extremely low, which attributed to a lack of budget. This is alarming as the DoH is sitting with R105 billion in legal fees. The national health budget is R248 billion. This means that the cost of medical malpractice is sitting at 42% of the national budget for health. If government cannot get its act together very quickly, money will be spent on legal fees rather than NHI services.

A consequence of this is that the Bill will further marginalise the poor and create unequal access to quality?healthcare services through the structure of its accreditation system. Under the NHI, all healthcare facilities will be required to get accreditation from the OHSC. In a 2019 Ideal Clinics report, the country had 3?477 primary healthcare facilities, and only 1507 were accredited as ideal clinics. In the NHI White paper, only those clinics that achieve 80% accreditation or above will be able to operate. In the OHSC report of 2018/2019, only 5 facilities achieved a greater that 80% score. The quality of healthcare facilities are vastly different between urban and rural areas as more resources tend to reach the urban areas. This means that majority of clinics in rural areas will not meet the minimum compliance standards in order to operate. Those living in rural areas would have to travel even further to get access to quality healthcare. Even though the Bill has a noble goal, the unintended consequences will indeed result in the lack of equal access to quality healthcare services, a stark contrast to its original intentions.

Increasing Taxes and Lacking Freedom Choice

Thirdly, the ruling party will, as proposed by the NHI Bill, remove common medical aid products, essentially wiping out an entire industry. They will pool all medical aid schemes savings and money made from an additional NHI tax on your income and locate it into a single NHI fund. This fund will be responsible for covering services that are approved for the NHI. The fund will be a public entity and the powers will be heavily concentrated with the Minister of Health. The fund’s autonomy is therefore undermined and this poses a massive risk for theft and corruption. One year into the pandemic a new acting minister has already been appointed, as our outgoing minister, Dr.Zweli Mkhize has been implicated in the Digital Vibes corruption scandal. To add fuel to the fire, section 11(1)(h) of Chapter 3 states that the fund will have the power to investigate complaints against itself. If those handling the fund, steal or mismanage the money, those are the very same people that will need to investigate it. One can only laugh at the ridiculousness of such an arrangement. Ideally, the complaints against the fund should be managed by an independent body, such as the health Ombud. National control is the wrong way to go.

The Result?

After the ruling party has taken away your medial aid, has mismanaged and poorly budgeted for the NHI fund, there will not be enough money to fund a variety of services. This will result the NHI in dramatically scaling down. This means that if you need medical attention for a costly procedure, if the NHI views it as too costly, it will not be covered and you will have no alternative safety net such as a medical aid scheme. Additionally, South African's will be forced to either forego the procedure altogether or pay out of pocket. Lack of funds will be the main reason for the removal of services the NHI will cover, along with a lack of services you will be forced to pay an additional income tax, the accreditation system will result in many clinics being unable to operate, the cost of medical malpractice will further destroy what is left of the NHI fund, and the fund will be controlled and managed by the minister. If the public doesn’t wake up now, the future of this country looks very depressing.