Proposals by the African National Congress (ANC) for a comprehensive reform of South Africa’s health financing system envisage shifting private healthcare to the public sector by employing a single-fund approach. This would mean replacing existing arrangements with a new centralized Government controlled institution as conceived in the National Health Insurance (NHI) Bill. While this has been under discussion for many years, progress has been slow.
Against this backdrop and in the context of the parliamentary Portfolio Committee on Health having concluded deliberations on the National Health Insurance (NHI) Bill, it is not surprising that there’s been many outspoken comments and views published by various sources. This coincided with the second Presidential Health Summit that was recently held.
The excerpts summarized in this brief represents a collection of notable thoughts and opinions from differing interest groups hoping to shape developments in the health-related sector. This article intends to give an abridged perspective of the dynamics at play.
National health insurance: Portfolio Committee on Health
National Health Insurance (NHI): Presidential Health Summit
A proposed course of action
Andrew Donaldson’s (economist and Senior Research Associate at UCT) contribution to the book Better Choices affirms that this is a complex policy area in which public and private institutions have both complementary and competing roles.
He goes on to state that whereas current reform plans envisage entirely new institutions to replace existing arrangements, more rapid progress might be achieved by building on and enhancing existing public and private sector capacity. The administrative competence of medical schemes provides an existing foundation through which a standardized benefit and regulatory reforms to achieve more effective delivery and alternatives to fee-for-service purchasing should be pursued.
Persistent delays in resolving issues are highlighted by the comments voiced by delegates at the Presidential Health Summit which, moreover, has been exacerbated by home-grown weaknesses including load shedding and a stuttering economy hinting at a government being in a state of limbo.
Although there is no argument with the moral imperative of universal healthcare, the critics argue that the plan reveals a set of aspirations largely divorced from the realities of public sector infrastructural problems and endemic capacity constraints brought about by poor governance as well as a lack of constructive engagement, competent management, and leadership.
Ultimately, we support a pragmatic approach as recommended by Andrew Donaldson and believe that the following factors will determine the success or failure of the NHI: a balanced funding model, collaboration between the private and public sectors, the availability of skilled management and a capable workforce, in addition to seriously addressing corruption.
Better Choices Ensuring South Africa’s Future: contribution by Andrew Donaldson