The aim of the NHI Bill is to bring better health care to more South Africans. Picture:Gallo Images
The aim of the NHI Bill is to bring better health care to more South Africans. Picture:Gallo Images

“It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so,” the US writer and humorist Mark Twain said.

What Twain taught us is that deeply rooted and firmly entrenched beliefs are difficult to change without the ability to think critically, and that when confronted by an opinion that contradicts our own, we tend to retreat more strongly into our entrenched beliefs.

The rationale of the upcoming National Health Insurance (NHI) is a no-brainer. Having medical coverage makes people healthier and enables them to get the care they need when they get sick or are injured. However, when the conversation on the National Health Insurance Bill remains vague and short on implementation, it produces anxiety and hostile responses.

To achieve universal coverage for all, we need to think critically, avoid retreating into entrenched beliefs and embrace a collaborative approach to achieve a calm, cogent, phased introduction of NHI.

Statistics published by the Institute of Race Relations show that out of SA’s population of more than 57-million people, only 17.4% are covered by a medical scheme. Only 9.5-million South Africans thus have access to private medical care.

Health insurance gives us the peace of mind associated with knowing that a health emergency won’t destroy us financially. Indeed, in the 21st century, access to quality healthcare is a basic human right. It cannot be that hundreds of people die every year, simply because of a lack of this access.

The truth is we have universal healthcare. People have the right to use public facilities. What is at stake is the management of the public facilities, let alone the quality of care, the infrastructure challenges and resources thereof.

Prime maladies

A workable co-operation between public and private health care is needed.

According to the World Health Organisation (WHO), our health system suffers from the following prime maladies:

  • Public health care is insufficient in most cases due to resource starvation and inefficient facilities and infrastructure, corruption and poor governance.
  • Private health care has become predominantly a private profit business, heavily curative-orientated and prone to excessive pricing.
  • The preventative aspect of health care has been neglected. The WHO says “how people live and take care of their health has been allowed to degenerate; the protective armour of disease prevention has weakened. Nutrition is poor. Rural and urban sanitation is dismal. Consumption of tobacco, alcohol and fast foods, and lack of exercise have become major risk factors causing a mega-epidemic of diseases such as diabetes, cardiac problems and cancers.”

It is not easy to define a road map towards a system of universal healthcare that is of decent quality and financially sustainable.

Participation of both

To meet the needs of the ill who have no access to quality healthcare we must provide integrated, sustainable and innovative solutions across the entire cycle of care.

NHI cannot be implemented by the government or the private sector alone. It will need participation of both, but more importantly, of the people.

How much are we willing to invest in helping people live less anxious, more stable lives? It is stated in the bill that NHI will be funded by a number of taxes — including a new payroll and personal income tax, and the scrapping of medical scheme tax credits.

Only through a collaborative approach can we get clear details of the contents and action plans of the NHI’s social compact, in which the public and private sectors can cooperate in meeting the health needs of the population through well-designed and implemented partnerships regarding infrastructure funding, service provision and overall health system strengthening.

While it is accepted that there have been challenges with various aspects of the private medical aid industry, the government can gain significant lessons and experiences from creating a more inclusive process that strategically taps into the skills and expertise within the industry.

This expertise could include creating an NHI legal framework that allows for a duplicative environment, which enables the NHI Fund to offer wider innovative product offerings that medical schemes and health insurers can provide to meet the population’s needs.

We at Afrocentric Group believe that providing details of the NHI’s benefit packages and elements of the transitional plan would assist in planning for the transformation required of the private sector and provide certainty for employers, employees and scheme members.

It is possible for a framework to be provided that could allow for the introduction of benefit options that could increase scheme coverage to a third of the population.

The national fund could also focus on the indigent, infrastructure development and resource planning and we could align those to have a national system that provides quality care to the entire country.

Numerous opportunities will continue to exist for the development, testing and implementation of mutually beneficial and innovative healthcare delivery models and solutions through partnership.

Regardless of our backgrounds, we all have a part to play in improving health services. It is a tall order and one that our society demands we get right.

The future of healthcare depends on how we shape it.

• Ahmed Banderker is CEO Afrocentric Group, SA’s largest health administration and medical risk management solutions provider, which owns health companies such as Medscheme, pharmaceutical distributor Pharmacy Direct, drug manufacturer Activo and several other health-related companies.

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