NHI a waste of time

The government cannot implement its National Health Insurance (NHI) plan in South Africa, and its continued focus on the topic distracts from the real problems in the country’s healthcare sector.

Wits School of Governance healthcare governance expert Alex van den Heever told BusinessDay TV that the problems with South Africa’s healthcare system are well known, well understood, and extensively documented. 

“The government has done nothing. The danger is that discussions about NHI distract from addressing real issues, creating the illusion of reform when nothing is happening,” he said. 

“A major concern is that NHI serves as an excuse to maintain the status quo, keeping those who profit from the system in place.”

His comments come after President Ramaphosa reaffirmed his commitment to the National Health Insurance (NHI) Act in his State of the Nation Address at the start of February.

The objective of the NHI Act is to provide universal access to quality health care for all South Africans, as enshrined in the Constitution.

This will be done by creating one “pool” of healthcare funding consisting of private and public providers.

However, deep uncertainty has surrounded this legislation. Although the Bill has already been signed into law, no further details on how the plan will be funded have been forthcoming.

In addition, reports have emerged that the provision in the Act requiring all medical schemes to fall into a single fund has been removed from the draft medium-term development plan for NHI.

This has left an already unclear legislative framework even more in the dark.

Van den Heever explained that the government’s NHI proposal is technically unfeasible, making it impossible to implement – at least in the medium term.

Therefore, the government is “chasing its tail” for a policy that it cannot truly implement.

“There’s no possible way that medical schemes can be eliminated or absorbed into a National Health Insurance Fund,” he said.

“It’s not feasible and that’s probably why there were discussions about taking it out of the medium-term framework because they couldn’t make a promise to do anything in the medium term.”

Van den Heever said South Africa should have universal healthcare, but this universal healthcare will never be free because someone will always have to foot the bill.

“Somebody’s going to always pay. The main issue is making sure you don’t pay when you use the service and that it doesn’t become a barrier to access,” he explained.

The person paying may be a taxpayer or an individual contributing to their own scheme, but it will never be truly “free”.

He said there is no alternative model that would work for South Africa, and the government’s plans for NHI will not materialise because of this.

Van den Heever explained that the government’s insistence on making an unimplementable plan work is a distraction from addressing the system’s real issues.

Touting the NHI as a solution when it cannot be implemented is a pretence that reform is happening when it is not.

Van den Heever called for more meaningful reform focused on real solutions, not distractions. 

“A major concern is that NHI is an excuse for the status quo – it keeps all the players that are currently milking the system in play,” he said.

“There needs to be reform, and there needs to be a focus on reforms that can address those issues, not distractions.”

He said the country will likely see heated conversations this year, not only within the Government of National Unity but also across the health sector. However, the government cannot be allowed to sit on its hands any longer.

“The concern is that the government is chasing a policy it can’t realistically implement while trying to scare the industry and health system with massive changes they can’t cope with,” he said.