The contentious National Health Insurance (NHI) Bill, which the National Assembly, the first house of Parliament, thinks would "achieve universal access to quality healthcare services" in South Africa, was passed on Thursday.
Ensuring that every South African receives an equal share of a failing public healthcare system will be the main aim of the NHI Bill.
The Covid-19 pandemic brought to light South Africa's starkly divided health system, which is made up of an increasingly dysfunctional public sector that serves between 65% and 80% of the country's population and a private sector that serves the 10% to 15% of people who pay for private medical care out of their own pockets and the 16% of people with private medical insurance.
The national health budget for 2022–2023 was R259 billion, or slightly more than 4% of GDP, according to the South African Medical Association Trade Union (Samatu), which is low by comparative standards.
The private sector, on the other hand, spent slightly more — 4.2% of GDP — on the 25% to 30% of the population to which it provided medical care.
The quality of service is top-notch in the private medical sector, but despite certain islands of excellence, the public sector is plagued by sub-standard administration, inadequate upkeep, a lack of employees, corruption and theft.
Free healthcare is promised for all under South Africa's proposed National Health Insurance (NHI) scheme.
The Office of the Minister of Health's NHI fund will be used to cover costs. According to the National Department of Health's official statement, funding would come from both the government's annual healthcare budget and a new NHI levy.
Members' premium payments to private medical aid funds will be replaced by the NHI fee. Paying for services and medications covered by the NHI will be prohibited by medical aid funding.
The public health system in South Africa is the country's healthcare crisis. Millions of the impoverished and jobless are not given the required care. Diagnostic tools, medical facilities, and hospitals are outdated.
There is a dearth of trained workers as well as a paucity of doctors, nurses, and medications. In rural places, millions of people travel great distances to see doctors.
For the public health system to be fixed, the government requires money. Additionally, it seeks to balance the amount spent on healthcare per person on public and private systems.
It will create an NHI fund and combine the premiums paid to medical aid programmes with the government's health budget. As a result, the government will be in charge of practically all health spending.
Taxpayers who pay for private healthcare also fund the entirety of the public healthcare system.
The National Department of Health claims that even though the NHI guarantees free healthcare, taxpayers will be responsible for paying for it, as well as the costs associated with running the provincial government health bureaucracies that administer the NHI.
"Free healthcare" is often synonymous with no healthcare around the world, with the US serving as Exhibit A.
Even worse, the World Health Organization's investigation revealed that “free healthcare” is actually expensive: some patients pay with their lives because the necessary care is not on the list of approved treatments.
Today, NHI is present in most nations. BioMed Central reports that there are various models. Some nations finance and supply all healthcare. In single-payer healthcare systems, the government covers all or almost all of the costs of both public and private healthcare. Many nations provide healthcare with a combination of public and private finance.
Despite their widespread use, the Free Market Foundation claims that all national health systems always struggle with rising costs: budget restrictions limit the number of procedures carried out each year, and physician and nurse shortages are frequent. The fact that thousands of patients must wait months or even years for specialised medical treatments sets them apart from other healthcare systems.
In all government-funded health systems, there are frequent shortages of, and overworked nurses and doctors.
The amount of treatment that a government can provide is constrained by its health budget, therefore, limitations or quotas on medical operations lengthen wait times. Only procedures and drugs that have been approved by the government's health agency are given to patients.
Different nations around the world have different ratios of public and private financing and service suppliers.
It is challenging to decide which arrangements are more effective because there are disparities in service types and levels as well as finance and insurance methods.
Can NHI be a success in South Africa?
Taxes that support the public health system are paid for by the same taxpayers who purchase private health insurance.
The National Institutes of Health claim that the planned NHI levy will reduce financing and care in the private health system by using the money people spend on private health insurance to pay for the NHI system. Private healthcare will be eliminated, and more medical professionals, nurses, and people will leave the country.
Of course there are issues. According to Business Tech, transferring money from the private to the public healthcare systems won't ensure that individuals who can't pay for it receive high-quality care.
The infrastructure of the public health system has to be repaired, including hospitals and clinics that need to be rebuilt and renovated, as well as new technologies and diagnostic tools.
Now, picture a healthcare system managed similarly to Eskom. Despite having no rivals, Eskom is unable to provide the nation with consistent electricity. When it comes to healthcare, would NHI become "Eskom"? Will it be added to the list of government failures as “health shedding”? Although the NHI will decrease private care, it is not certain that public healthcare will advance.
South Africa is at a turning point in its effort to provide universal healthcare.
Although the NHI promises to provide everyone in South Africa with access to healthcare, Profmed's CEO, Craig Comrie, raises serious concerns that could impede development and jeopardise the standard of treatment provided to all citizens.
“We recognise the importance of the NHI Bill's goals, but there are still some provisions in the Bill that we are concerned may make it more difficult for people and medical scheme members to get necessary healthcare services,” said Comrie.
Comrie emphasises that if these issues aren't addressed, the Bill's implementation in its current form might have significant effects on South Africa's healthcare system, raising doubts about the system's claimed benefits.
South Africa has millions of unemployed people who rely on government benefits to survive. An expanding economy that generates jobs that allow people to pay for housing, food, and healthcare is necessary for universal healthcare.
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