Fears of NHI emigration ‘overplayed’ 

Executive Director of the Centre for Universal Health at Chatham House Robert Yates said fears that a National Health Insurance (NHI) system would cause medical professionals and taxpayers to leave the country are overplayed.

In the past few weeks, many industry roleplayers have critiqued the government’s NHI Bill, which the National Assembly recently passed.

The critics claim that the government will not be able to implement the Bill effectively and that an NHI system would leave South Africans worse off.

Another critique is that it will cause medical professionals, including doctors and nurses, to leave the country because they do not want to work under an NHI system in South Africa.

Trade union Solidarity has said that its research shows doctors in South Africa are unwilling to work under the new NHI scheme, with many saying they will leave the country. 

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

Noach said the planned NHI system creates a negative sentiment among healthcare professionals, which can damage the healthcare sector.

“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.”

Another concern of critics is that taxpayers will take the same route and leave the country should NHI be implemented.

The NHI Bill will largely be funded by tax revenue, and an estimated annual R300 billion to R460 billion would be needed to fund NHI.

This would, therefore, require an increase in taxes, which many say the country’s small tax base cannot afford.

Economist Dawie Roodt recently warned that there is no room to increase taxes as rich people and companies will leave the country if it happens.

“Combined with the high crime rate and economic instability, higher income taxes will drive rich people out of the country,” Roodt said.

However, Yates told Daily Investor that these fears are overplayed. “Because where will these taxpayers and medical professionals go to when virtually all the countries in the OECD have a predominantly publicly-financed Universal Health Coverage system in place already?”

He added that it is “one thing for people to say that they intend to leave and another thing to uproot themselves and their families to actually do it”. 

In addition, other countries that have launched a universal health system have not experienced an “exodus of health workers” on a significant scale, and Yates, therefore, does not believe it will happen in South Africa.

Rather, Yates believes NHI would hold huge benefits for South Africa, even beyond the healthcare sector.

In summary, these benefits would include:

• Health benefits – the population living longer and in better health. There would also be reduced health inequalities between different socio-economic groups, which I appreciate is a top priority for South Africa.
• Economic benefits – Universal Health Coverage (UHC) reforms have been shown to be a major driver of economic growth. They create employment opportunities, reduce health-related poverty, and reduce inefficient saving (for health emergencies), which stimulates domestic consumption, and they are a good basis for strengthening the social contract whereby people are more likely to pay their taxes when they receive free health care.
• Societal benefits – UHC reforms are also a good way of reducing economic inequalities and inequalities between regions and also build confidence in the state.

“Countries that introduce universal, publicly financed health systems, like the NHI, find that it brings huge benefits way beyond the health sector, which I would expect would be the case in South Africa,” he said.