Health Minister Dr Aaron Motsoaledi states: “The NHI is a health financing system which is meant to be an equaliser between the rich and the poor. What we all agree on is that all patients and the extremely sick should benefit from the best medicines and care science has to offer, not just the rich or the employed. From a moral point of view, the rich and the employed people can drive luxury cars and live in mansions, eat cake and caviar, leaving the rest behind to rely on public transport and to live on bread and pap or soy beans. However, when it comes to medical care our moral compass (forget communism or socialism) must guide us to a more equitable and fair dispensation.”
1. There are differences in opinion but the three basic points of view will cover most of the principles as a starting point
“The private sector is inefficient and unsustainable eventually, while the National Health Insurance (NHI) offers a cost-effective solution,” according to Dr Olive Shisana, an honorary professor at the University of Cape Town and special adviser to President Cyril Ramaphosa.
On the other hand, some claim the new healthcare legislation is unimplementable, unaffordable, unclear, and unlikely to happen any time soon.
The third view is not for or against the NHI but suggests a different approach. According to Marcus Low, editor of Spotlight, “One of the most damaging aspects of our public discourse on the National Health Insurance is the mistaken notion in some quarters that the only two options are the NHI and the status quo. Whatever your position is on the NHI, what is indisputable is that the NHI represents a major disruption from the path we have been on until now.”
2. A fact to consider
The department had a budget of R62.2 billion for the 2024/25 fiscal year.
3. Doctor-to-patient ratio in South Africa
According to the South African Medical Association (SAMA), there are approximately 57 000 doctors currently practising in South Africa, according to the South African Medical Association (SAMA).
Various statistical numbers are guessing the average salary paid to doctors, and my estimate rounded to R100 000 per month. Therefore, the gross salaries paid to doctors exceed R68.4bn per annum. It can be assumed that the South African Revenue Services (Sars) collects a neat sum of at least R21.34bn per annum. This is a very substantive number which the fiscus cannot put at risk of losing on a large scale. Should the worst scenario play out and our doctors leave the country en masse it will place not only healthcare at risk. A balanced approach is obviously required.
4. Medical Aid members
The share of medical aid scheme members in South Africa in 2021/2022 by population group:
As of 2022, 15.8% of all individuals in South Africa were members of medical aid schemes, which presents a slight decrease from 16% recorded in the previous year. Considering the total population in the period under review, this accounts for around 9.7 million residents having private medical care. This leaves approximately 52 million dependants on public healthcare, with a share of 84.2%. When comparing membership rates by population group, coverage by medical schemes were noticeably higher among white individuals (at 71.9%) and Indians/Asians (at 48.7%) than among coloureds (at 18.2%) and black Africans (at 9.7%).
From a political party perspective there are ideological differences which seem to coincide with the political party’s constituency base. The DA “fully supports the principles of universal healthcare that underpin the NHI, but we believe that South Africa has neither the capacity nor the finances to implement the NHI Bill as it currently stands”.
Rise Mzansi MP Makashule Gana said the party wanted the budget to ensure that doctors and nurses were employed; that critical posts in hospitals were filled and healthcare facilities refurbished; that “ethical professionals” were appointed to the department; and that “a concerted effort” was made for the provision of mental health services in primary healthcare facilities and clinics.
According to a study undertaken by Stats SA, hospitals dominate healthcare expenditure.
Hospital services accounted for the biggest chunk of provincial healthcare spending. The nine provincial administrations spent R125.6bn on hospital services in 2019/20, accounting for 61% of total healthcare expenditure. The second biggest item was public health services (R69.1bn or 33%), followed by paramedical services (R8.6bn or 4%) and other smaller items (R3.3bn or 2%).
Interestingly, the provinces with the largest contributions to hospital services as a percentage of total healthcare spending were Gauteng (68%) and the Western Cape (65%). Hospital services include the operations of all government hospitals, both general and specialist as well as medical centres, nursing homes, and maternity centres.
5. What the Bill proposes
“To achieve universal access to quality healthcare services in the Republic in accordance with Section 27 of the Constitution; to establish a National Health Insurance Fund and to set out its powers, functions and governance structures; to provide a framework for the strategic purchasing of healthcare services by the fund on behalf of users; to create mechanisms for the equitable, effective and efficient utilisation of the resources of the fund to meet the health needs of the population; to preclude or limit undesirable, unethical and unlawful practices in relation to the fund and its users; and to provide for matters connected therewith.”
No right-minded person will disagree with these intentions. All we need to do now is implement these lofty goals. We have a good start with the Government of National Unity (GNU) where a more cooperative approach can be fostered, and experts can offer inputs. It is also high time that large medical corporations like Discovery use their entrepreneurial skills for the greater good of the population.
Since they have expanded in life and insurance products as well as banking products and have become the most data-based institution, they can direct their insights into collaborating with the politicians to ensure a fair dispensation in our country. “By developing an in-depth understanding of clients’ financial habits and offering incentives for improvement, not only do our clients benefit, but we as a bank benefit from improved experience while contributing to a more financially resilient society,” according to Discovery.
This is a suitable time to contribute to society. We must become a more equitable society.
* Kruger is an independent analyst.
** The views expressed herein are not necessarily those of IOL or Independent Media
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