News Desk | NHI | Editorial
 

South Africa’s healthcare challenges: Could this new plan offer a viable alternative solution to the NHI?

Time to read: 03:31 minutes
 

9 September 2024
Editorial by Linda Ravenhill

An alternative to the NHI has emerged, and it's tentatively gaining traction and may even be supported by some of President Cyril Ramaphosa's allies.

The plan, presented last week by Dr Richard Friedland, CEO of Netcare, on behalf of the Hospital Association of South Africa (HASA), addresses some of the major criticisms of the NHI, including its lack of affordability and slow rollout. To our knowledge, it is the only proposal to offer an actual workable alternative to the NHI. 

The key tenant of the proposal is that healthcare insurance be made mandatory for all formally employed workers.

According to HASA, this approach could eventually see medical aid coverage extended to 27.5 million people, ultimately increasing per capita public expenditure on public health users by a healthy 52%, freeing up considerable financial resources which would have the knock-on effect of improving public healthcare delivery.

So, where do those figures come from?  Well, according to BusinessTech, one of our sources, HASA worked them out as follows:
 

• Of our total population of approximately 60 million, 11.5 million people are formally employed
• If one then applies an average ratio of 2.4 dependants to the 11.5 million, that equates to 27.5 million people who could potentially be covered by medical insurance
• That would leave the remaining 35.5 million unemployed people—some 56% of our population—dependent on the public system
• This reflects a 29% reduction in dependency on the public healthcare system, where the government currently provides healthcare for 85% of the population

If one considers then that the latest per capita public expenditure, based on a consolidated health budget of R271 billion and excluding those who are currently covered by a medical scheme, equated to R5,054 per person, the increase in formal employment coverage would increase the per capita public expenditure for public health users by 52% to R7,659, freeing up significant funding to improve healthcare delivery for those reliant on public services.

So much for finances, but how does the plan address one of the main criticisms of the NHI, namely that it would take too long to implement, leaving the majority of the population without access to adequate healthcare services?

Well, here too, HASA has a plan, proposing a phased approach for their solution, which looks something like this:
 

• Phase 1 would include formally employed individuals above the tax threshold, increasing medical scheme coverage from 9.2 to 15.4 million people 
• Phase 2 would extend coverage to the remaining formally employed population, expanding medical scheme coverage to 27.5 million people
• Phase 3 would focus on economic growth and employment recovery, further easing the burden on the public healthcare system
   

Friedland emphasized that this approach is not new. In Africa, 61% of countries have mandatory contributory healthcare programmes for civil servants. He further pointed out that the ANCs own 1994 Health Plan had recommended mandatory health cover for the formally employed.

HASA believe that implementing this compromised solution could bring immediate benefits to South Africa's public health system. Reducing the public sector's patient load would ease the strain on healthcare workers, reduce overcrowding, and provide additional funding to address critical shortages and infrastructure issues. 

According to Friedland, this would also enable the system to tackle the growing shortage of healthcare professionals, including an estimated shortfall of 27,000 nurses, expected to rise to 70,000 by 2030.  To do that, however, we would argue that the Minister of Health would first need to revise the wrecking ball of changes unleashed in his first term, that effectively dismantled the nursing training system.

That said, the proposed alternative plan has been positively received by some within the government, who view it as a viable compromise to mitigate opposition to the NHI. 
It isn't easy however, to see those those dedicated to enforcing the current NHI plan agreeing to any such compromise.

But for now, it's the first plan we've seen that presents a plausible alternative to the NHI: it still delivers on the need for universal care—both financially and in terms of time to implement—while effectively addressing the contentious Section 33 of the NHI Act  -  the right of the individual to choose a private medical aid - currently one of the major stumbling blocks of the NHI in its current form. 

So far, there's been little to no response from the powers that be. Let's see what the week ahead holds. 


This story was compiled from various sources, including:
 

8 September | The City Press | Ramaphosa allies warm to new NHI compromise option, but Motsoaledi and others aren't buying it
8 September 2024 | BusnessTech | NHI 'compromise' option for South Africa
4 September | BizNews | The "Mandatory Cover" healthcare scheme that the ANC should adopt over NHI

 

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