NHI to cut national spend on health care
Donwald Pressly and Londiwe Buthelezi
South Africa was spending about 8 percent of its gross domestic product (GDP) on the health sector and this would likely be reduced to around 6 percent once the National Health Insurance (NHI) system was running, Olive Shisana, the chairwoman of the health ministerial advisory committee, said yesterday.
Addressing the Cape Town Press Club, Shisana said that the current system was inequitable as 4.1 percent of GDP was spent on private health care, which covered 16.2 percent of the population. About 4.2 percent of GDP was used on the public health sector, which covers 84 percent of the population.
The spending on health care needed to be spread through the proposed NHI – which is similar to a system introduced in the UK soon after World War II – and it will be mandatory for all South African citizens and residents to belong to.
Pressed on whether those enjoying private medical aid could opt out of their medical schemes – to avoid the burden of double payments for medical insurance – she said this would have to be negotiated by trade unions with employers. The NHI would be based on a cross-subsidy system with the richer making greater contributions, she emphasised.
Shisana, a former health director-general and now head of the Human Sciences Research Council, noted that spending on health was R11 150 a person in the private sector but only R2 766 a person in the public sector.
Meanwhile, Health Minister Aaron Motsoaledi warned that if the private and public health sectors did not put their differences aside, they would go down together because the failure of the health-care system was not apolitical, but an indication that the country was doing something terribly wrong.
Speaking at the Hospital Association of SA’s (Hasa’s) annual conference in Cape Town, the minister said South Africa was spending more in terms of GDP per capita on health care than some countries in the Bric bloc of Brazil, Russia, India and China, but its life expectancy was “in the red”.
He said both the public and private sectors had to address this because in nine out of 10 challenges facing health care, the two parties were “swimming together”.
“The development of the country is measured by child mortality and it is a common saying in the country that this is the fault of the public sector, but we are all operating in the South African health sector so it is the fault of the whole health-care sector,” he said.
Motsoaledi said this was the reason why health reform was needed in South Africa and although a “few feathers would be ruffled in the process” he was not targeting individuals.
He was aware that some within Hasa might regard the reform as a move to destroy what they believed and were engaged in, but the two sectors would have to find common denominators because “we have reached a time that we can no longer run away from the NHI”.