NATIONAL HEALTH INSURANCE
Navigating a route up the NHI mountain
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niversal healthcare in South Africa is a natural extension of incremental legislation aimed at meeting the government’s constitutional obligation to create equitable access to healthcare for all – currently available at nowhere near the scale required. Intense debate roils around the government’s healthcare track record, high medical inflation, profit-oriented private medical aids and private sector over-servicing. Whether South Africa can afford an estimated R500 billion, phasedin National Health Insurance, NHI, in the current parlous economy – recently degraded by institutional corruption and Covid-19, is also hotly contested. As with all redistributive moves, those who stand to lose the most complain the loudest, whether they be healthcare businesses or higher-income taxpayers. Many problems in the South African healthcare system can be traced back to the apartheid era (1948-1993) when the healthcare system was highly fragmented, discriminating between four different racial groups (black, mixed race, Indian and white). To worsen the situation, the apartheid government developed 10 Bantustans (the so-called ethnic homelands) into which Africans were unwillingly segregated, each with their own departments of health. It’s been 27 years since the first democratic elections allowed racial and geographical integration to begin addressing gaping inequities in resource
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distribution and delivery. The NHI is an attempt to comprehensively deal with this legacy, making it a steep mountain to climb – and the air seems to have got thinner half-way up. Most rational protagonists agree that it’s a moral imperative to create equal healthcare in a country with the world’s worst Gini co-efficient and such severe structural imbalances. Where it gets really interesting is in the ‘yes, but how?”
Government’s answer The government’s answer is a health financing system designed to pool funds and actively purchase services
B US I N E S S G U I D E T O QU AL IT Y HEA LT HCARE 2 0 2 1
more cost-effectively to provide universal access to quality health services for all South Africans based on their health needs – irrespective of their socio-economic status. All NHI services will be provided free at point of care. At present the money South Africa uses to buy healthcare sits in several different pockets or “pools” – across dozens of individual medical schemes – and in the public purse. When money is split like this over many, smaller pools – which in the case of medical schemes are accessible only to a privileged few – it limits any
