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The release of the latest white paper on the National Health Insurance Policy (NHI) brought less certainty than was expected to the public and especially the health sector. Reference is still made to the previous version of the policy, which stated that R256 billion would be required to fund the NHI by 2025 at an expected economic growth rate of at least 3,5%. These figures are still the same as those introduced in 2010 at the first mention of the NHI.

AfriBusiness is of the opinion that, were the NHI a business plan to be considered by any businessman, the conclusion would be that it would fail.

“If it were to be implemented, we would be at risk of losing medical practitioners due to increased workload, expected payment issues and an overall dissatisfaction with the performance of the NHI,” says Armand Greyling, Law and Policy Analyst at AfriBusiness.

“South Africa currently faces a recession and its credit rating has already been downgraded. We are left with a small formal tax-paying workforce who are expected to carry a vast population financially. The question is not be whether the NHI will fail, but how disastrously it will fail and what the overall effect of this failure will be on healthcare and the country as a whole,” Greyling adds.

AfriBusiness is also of the opinion that the Department of Health will be better off implementing a plan to bring all public healthcare facilities on par with those in the private sector, rather than attempting to merge the private sector with government entities.

The business rights watchdog submitted commentary on the then-proposed NHI model in May 2016 and stated its concern about the lack of an economic impact assessment and the blatant disregard for the effects of the proposed tax-mixture to fund the NHI.

What the Department and its Minister, Aaron Motsoaledi, seem to pursue is a model that pose a massive administrative and bureaucratic challenge. The Minister seems to link it to other foreign models such as Obamacare in the USA and the NHS in the UK.

These respective initiatives each come with their own sets of problems, which would be increased exceptionally in South Africa.

Abroad, Obamacare and the NHS have resulted in people queuing at emergency rooms and have further exhausted state funds due to the public’s medical demands. This is among other things the result of higher-than-expected costs and strikes by medical practitioners as a result of late or poor payments. “It simply seems as if Government attempts to nationalise healthcare in South Africa by removing the differentiation between private and public sector,” Greyling says.

Greyling further emphasises the high levels of uncertainty among medical schemes regarding their place in the NHI system. “Even entities such as emergency medical services (EMS) which include privately-owned ambulance companies will be affected due to various regulations.”

AfriBusiness is also of the opinion that putting all funds into one scheme in a country that is tormented by corruption and allegations of state capture is a very real risk.

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