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Opinion: The implications of National Health Insurance (NHI) in South Africa

12 November 2009
Access to quality healthcare is currently not a reality for many people in South Africa. Is NHI the answer? Photo by: US Army Africa

Access to quality healthcare is currently not a reality for many people in South Africa. Is NHI the answer? Photo by: US Army Africa

This opinion piece appears in our latest newsletter. What do you think about the proposed National Health Insurance? Please comment below. If you are interested in receiving our newsletter, please email lindy@developmentworks.co.za.

There are few emotions as unsettling as uncertainty, the dread of the unknown, the fear of what tomorrow may bring.  There are countless developments surrounding us and we wake up each morning to ever-more-grim realities.  More recently in South Africa, the issue of the National Health Insurance (NHI) has generated just this type of anxiety.

The NHI is based on the principle of universal access to healthcare for all South Africans.  The aim is to make healthcare more accessible and affordable for all.  As expected, the NHI will impact differently on individuals, the public and the private sector.  Although most of the discussions are still hypothetical, the guidelines are already irking some.

Medical and pharmaceutical organisations have been trying to make sense of how they might find their place in the NHI and, more importantly, whether the NHI is an appropriate response to providing health within a comprehensive system of social security.  It is impossible to implement an NHI system successfully without this type of debate.

Moral imperative

South Africa needs to reform its public health system. Photo by: World Bank

South Africa needs to reform its public health system. Photo by: World Bank

The bottom line is, it is difficult to argue with the moral imperative behind the NHI, as urgency and commitment of all stakeholders towards creating an efficient system for all South Africans is important, particularly in light of the HIV and AIDS pandemic. However, South Africa first needs to reform its public health system and address the already existing challenges, such as staff shortages and lack of infrastructure, to make sure that it can support the NHI in the long run.

Also, some experts have cited potential challenges which may arise as a result of shifting from a tax-funded public health system to an insurance-funded one.  Some practical issues, such as the implications of allowing individuals who previously used state facilities to choose where to “spend” their insurance benefits, also need to be clarified.

Other experts have also cited potential benefits of the NHI. Maya Fisher-French, in her article published in the Mail & Guardian dated 14-20 August 2009, also stated potential benefits to members of medical schemes, the private sector and government. Her analysis is as follows:

Benefits:

There might be some benefits to National Health Insurance. Photo by: World Bank

There might be some benefits to National Health Insurance. Photo by: World Bank

Benefits to members:

•    They can continue as normal with medical bills administered through the medical scheme;

•    They can continue to access private facilities that remain of a higher standard than public facilities;

•    They can continue to access all the medical services  covered by the existing medical scheme; and

•    They can opt out of the medical scheme at any time.

Benefits to private sector: Continues to exist. As the medical schemes become more affordable because of the lower premiums, it is possible that medical scheme membership would actually increase under this proposal.

Benefits to government: Government can leverage off the existing infrastructure of the schemes’ administration systems.  It can also tap into the claims and cost-management experience of large schemes.

Lessons from other countries

Proposals for national health systems have also been made in other countries. Photo: World Bank

Proposals for national health systems have also been made in other countries. Photo: World Bank

This is not the first time the concept of NHI is being considered and there are many lessons to be learnt from other countries. One of Barack Obama’s reform plans involved the introduction of a national health system in the United States of America and this also caused a heated debate among the Americans, particularly as some felt this was bent on government takeover of private healthcare.  In Britain, on the other hand, the National Health Service (NHS) has been implemented since the 1940s and the British have nothing but praise for this system.    The Britons claim that through the NHS, 1 million people gain access to healthcare every 36 hours.  In response to an attack against Obama, Prime Minister Gordon Brown added his voice to a twitter campaign saying “The NHS often makes the difference between pain and comfort, despair and hope, life and death.”

On his recent visit to South Africa as part of the African tour, Michael Sidibe, UNAIDS executive director, was also asked for his opinion on the NHI and whether the NHI would eliminate the need for a private health care system.  In his response, he emphasised the need for intensive and open dialogue between the public and private health sectors.  He also added that key in the implementation of the NHI is the understanding that the NHI will not eliminate the private healthcare system, but that this is a formalised opportunity for the two sectors to complement each other and ease the burden on the health system.  More importantly, the process of formalising the NHI should focus on issues of equity, redistribution of opportunity and social justice.  If it does not, this will foster the development of a parallel system and a breakdown in the system, Sidibe said.

Clearly, if South Africa is to launch the NHI, it will be necessary to tailor it to the country’s needs and, should it be successful, it will present a model for building stronger public-private partnerships.

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