EDITORIAL: An unclear bill of health
South Africans have lost faith in a public service that has forgotten how to serve
There is no question that health is a human right. A healthier nation is a more harmonious, productive and prosperous one. So it’s hard to find fault with the government’s aspiration to end SA’s deeply inequitable health system, which sees the well-off paying for high-quality private healthcare while the poor are left to take their chances with the state’s patchy offerings.
Last week Health Minister Aaron Motsoaledi unveiled the first piece of enabling legislation for the government’s policy for achieving universal healthcare. The National Health Insurance Bill proposes establishing a central fund, financed with mandatory contributions from those who can afford to pay: the fund will purchase services on behalf of the population from accredited public and private sector providers. This is a far more complex system than the existing one, which the government has failed to fix. And the trouble is South Africans have lost faith in a public service that has forgotten how to serve.
The National Health Insurance Bill leaves critical questions unanswered, including how it will be financed and what mechanism the government will use to determine a fair rate for paying private service providers.
Motsoaledi can rightly claim progress since he assumed his post in 2009 in the massive expansion of HIV and TB treatment programmes, which are lauded the world over.
But he has yet to deliver on the assurances that National Health Insurance was contingent on improving the quality of public hospitals and clinics. His more recent insistence that improving the state of healthcare is an ongoing project and that its failings should not be used as a stick to beat back National Health Insurance does not wash.
The oncology crisis in KwaZulu-Natal, the Life Esidimeni mental healthcare scandal and Mpumalanga’s deteriorating institutional maternal mortality rate are but three examples of how the public healthcare has failed people.
The government as a whole has a dismal track record in managing large funds intended for compensating injuries sustained at work or on the roads. The Compensation Fund, overseen by the Department of Labour and responsible for remunerating people for work-related injuries, has long frustrated doctors and claimants with its extensive delays. And the Road Accident Fund is technically insolvent and has contingent liabilities of close to R190bn. National Health Insurance will be far more complex to administer, with a far larger pot of money for the unscrupulous to plunder.
The National Health Insurance Bill leaves critical questions unanswered, including how it will be financed and what mechanism the government will use to determine a fair rate for paying private service providers. Many players in the private healthcare industry will be willing partners, but only if the price is right and they get paid on time. If not, SA’s highly regarded doctors and nurses will be the first to seek jobs elsewhere.
Nor is it clear how National Health Insurance will remedy the corruption and lack of accountability that characterises so many provincial health departments. Equally worrying is the vagueness around the future of medical schemes. The minister has for years prevaricated on this politically sensitive issue, one minute saying he will not stand in the way of anyone who wants to pay for medical scheme cover in addition to their mandatory National Health Insurance contributions, the next insisting schemes should be relegated to providing only complementary cover.
While he now says they will continue to play a role, the Medical Schemes Amendment Bill (published alongside the National Health Insurance Bill) contains a clause that may well sound the industry’s death knell: it says the registrar of medical schemes may restrict the benefits schemes offer to eliminate duplication of cover provided by the National Health Insurance fund. To the minister’s credit, some of the Medical Schemes Amendment Bill’s proposed changes are long overdue and promise a better deal for consumers, including much tighter scheme governance and a better system for dealing with complaints.
The challenges confronting the government as it presses ahead with National Health Insurance are immense. It is vital that it runs a thorough public consultation process and heeds the input of the many experts who truly do want to see a better healthcare deal for the nation.
If not, it risks breaking what little still works.