The National Health Insurance (NHI) white paper is arguably the most important piece of new legislation since the Constitution. Our health is at the base of all other economic and social issues.
Good health is what allows us to work and think. It allows us to not miss days at school or have to stay home and look after others. Without decent healthcare we cannot function as a community or strive as an individual. It is at the heart of everything we do from the moment we wake up.
Yet in South Africa, 84 percent of people do not have health insurance and rely on the overstrained public healthcare services provided by government.
Since the NHI green paper was initially released in 2011, the development of a white paper has been kicked down the road, but Health Minister Aaron Motsoaledi announced last month that its release may finally be imminent. The white paper is a more detailed outline of how the NHI will work.
The NHI white paper will detail exactly which healthcare services will be offered under the new scheme, who will be responsible for delivering them, and how they will be paid for. The programme will be free at the point of delivery and universal – in other words, available to all and non-discriminatory on any factors, including income levels. It’s a highly contentious programme that will affect everyone. If implemented properly it will provide a net benefit to the vast majority of South Africans, including the 16 percent that currently make use of private healthcare.
Financial benefits
Aside from it being a basic human right, access to good healthcare has significant financial benefits to the economy. Poor health decreases the labour participation rate, makes businesses less productive, and drains resources that are needed to push the economy forward. A healthier population means people have more disposable income and more time and are therefore freer to contribute to the value-adding economy through spending, investment or labour.
The problem is, of course, that such a system costs money – a lot of it. The NHI is expected to take 14 years to become fully operational and will cost around R250 billion to roll out (excluding the costs of actually providing healthcare services).
It’s a necessary and overdue addition to South Africa’s development, but it needs to be implemented properly, so that it does not choke itself on legal complexity or crumble under misaligned incentives. To be successful, it requires a high level of informed public involvement, that includes individuals, the private sector and non-profit organisations. When eventually the white paper is released, it needs to take centre stage in public discussion. The presumption in many cases is that South Africa cannot afford it or does not have the capacity to implement it. It can and it does.
Highly developed and wealthy economies such as the United Kingdom or Norway are not the only countries that have managed to cover all citizens with basic, free healthcare. Crisis prone Argentina has achieved it. Brazil implemented its free healthcare policy in 1988. Rwanda started its national health plan in 1999.
Each case is different, but South Africa does have the resources and the institutional capacity necessary to achieve comprehensive national health insurance. It’s going to take political will and national collaboration to make sure it is done properly.
* Pierre Heistein is the convener of UCT’s Applied Economics for Smart Decision Making course. Follow him on LinkedIn/in/pierreheistein.
** The views expressed here do not necessarily represent those of Independent Media.
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