South Africa

NHI will fix South Africa’s broken healthcare system – Crisp

Deputy Director General of National Health Insurance (NHI) Dr Nicholas Crisp said NHI is intended to simplify and improve South Africa’s broken healthcare system.

The National Assembly recently passed the NHI Bill, which is aimed at introducing universal healthcare.

The Department of Health explained that National Health Insurance provides good healthcare for all by sharing the money available among all South Africans.

However, the Bill has drawn a lot of criticism, with many saying its provisions are unclear, it will root out competition and choice in the healthcare sector and cause doctors and nurses to leave the country.

Crisp told 702 that, despite this recent backlash, many support NHI in South Africa.

“There are many who do support it, especially the poor and marginalised people of the country, many non-government organisations, several political parties, the whole of Cosatu and our biggest backer is the World Health Organization, who is cheering us on from the sidelines,” he said.

He said the problem with South Africa’s current healthcare system is that it is complicated, duplicative, inefficient and “does not achieve the kind of outcomes that we should be getting for the investment we invest”. 

Through NHI, the government wants to “do away” with duplications and complexities by simplifying the country’s healthcare system.

“Instead of having nine provincial departments and 72 medical schemes paying for healthcare and hundreds of providers who have to find their way between those different funders, we want to have one common fund with one set of benefits,” said Crisp.

He said budgeting is one of the most complex issues with the current system.

Budgets are currently administrated through the nine different provincial departments and not the national Department of Health.

According to Crisp, this is extremely complicated, and those budgets are not allocated to health departments by the National Treasury.

Rather, he explained that these budgets are allocated to the province, and then the provinces manage the public sector.

This means that the provincial health departments have little to no control over their infrastructure and human resources.

“So there are many structural problems in how our Constitution divides just the functions to the public sector.”

Crisp said the private sector is an “even bigger problem because it has become a free-for-all”. He said because the private sector is “extremely unregulated”, its prices are uncontrolled.

However, Crisp assured South Africans that there is “nothing sudden about NHI”, as it will take many years to implement a system like this.

“We are working into the future, and in other countries, reforms of this size have taken anything from 15 to 30 years,” he said.

“Of course, the devil is in the detail. We know that. We’ve been working on this for many, many years.”

In response to concerns about NHI’s funding, Crisp has said that about 8.5% of GDP is already spent on healthcare and once duplication and inefficiencies are removed from the system, the funding gap isn’t as big as NHI critics fear.

Private sector

Busisiwe Mavuso

Business Leadership South Africa CEO Busi Mavuso has warned that NHI, as envisaged in the Bill, would leave all South Africans worse off.

She said a single-buyer model “interferes with accountability by removing the buying decision from the patient”.

“Instead, an elaborate bureaucracy must somehow oversee care quality to overcome the problem that patients will no longer be able to choose their providers.”

“The monitoring costs, if the quality is going to be maintained, will swamp the purported gains from economies of scale. And the reality is that the healthcare system as it stands often fails to monitor care quality.”

Others have also raised concerns that NHI would make healthcare professionals leave the country.

Discovery Health CEO Ryan Noach and the South African Medical Association warned that the NHI risks chasing doctors and other healthcare professionals out of the country.

“In the short term, we believe the biggest risk of the NHI Bill is medical professionals leaving South Africa,” he said. “It creates a negative sentiment among healthcare professionals.”

Head of the Solidarity Research Institute Connie Mulder has also warned that NHI would require a massive increase in taxes, which could make high net-worth South Africans leave the country and hurt the economy.

“We are talking about massive increases in taxation to fund this, which will crush South Africa’s economic outlook,” Mulder said. “It is completely unaffordable and unnecessary.”


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