SA Health Professions Council president Dr Kgosi Letlape told academics and medical professionals at a discussion on whether the NHI white paper meets human rights objectives of the constitution, that private medical aids and the Medical Schemes Act should be abolished if the NHI was to provide universal health care access for all citizens.
Letlape was speaking at a public discussion at the University of KwaZulu-Natal in Durban on Friday.
“There can be no national health if it is not for all of us. You try to engage about NHI with the privileged, and they say ‘don’t touch my medical aid’. Medical aid is a crime against humanity. It is an atrocity.”
Letlape said Health Minister Aaron Motsoaledi did not seem to have much support for NHI, and people such as parliamentarians and judges also had an attitude of “don’t touch my medical aid”.
However, he said it was possible to provide universal health care, which was not a new concept, as the country previously had one of the best health-care systems in the world under apartheid.
“South African whites had health for all. By 1967 they had a system that could give somebody a heart transplant for no payment. At the point of service, there were no deductibles, the doctor was on a salary and everyone could access health care.”
But when the Medical Schemes Act was created 50 years ago, the exodus of medical professionals from the public to the private sector began, Letlape said.
He estimated there were between 3000 and 4000 medical professionals working for medical schemes that could be redistributed to the health system if schemes were abolished.
Dr Mfowethu Zungu, deputy director-general for Macro Policy, Planning and NHI at the KZN Health Department said only 48% of expenditure on health in South Africa was spent in the public sector, which served 87% of the population.
The balance was spent in the private sector, which served medical aid members, who comprised around 17% of the population.
Dr Hanif Vally, deputy director of the Foundation for Human Rights SA, said medical aid created a divide, as 50% of the country’s doctors and an even greater number of specialists served around 18% of the country’s citizens, who had access to the private sector.
“Medical professionals are going into private practice, inequalities are being worsened and people are not realising their constitutional rights."
Heath Department deputy director-general for Health Regulation and Compliance Management, Dr Anban Pillay, said the provision of universal health care for all citizens was critical.
“We currently have a system where people access care based on what they can afford. Clearly, there are a number of barriers to access, particularly in the lower socio-economic groups. NHI is a massive reorganisation of the public and private health-care system.”
Pillay said the poor were often most in need of health care, and funding for NHI would come from taxpayers based on a principal of social solidarity.
“Social solidarity means we all contribute to a fund, so that when I am sick I will have access to health care. But maybe I may never need to (access), but somebody else will.
“It’s not a concept South Africans are particularly used to in the current context. If you look at your medical scheme environment, which an individual contributes to as an insurance, you have a particular entitlement – it’s your money. This is very different to how the NHI works.”
In younger, healthier years, South Africans would contribute to the fund and were likely to derive benefits from that contribution only later in life.
“The young and healthy should subsidise the sick and old. This is not about investing in something where you are going to derive some profit. It’s investing in society so you can build society,” Pillay added.