Baragwanath Chris Hani Hospital. Picture: BUSINESS DAY
Baragwanath Chris Hani Hospital. Picture: BUSINESS DAY

The envisaged national health insurance (NHI) seems to be based on the notion that the quality of healthcare depends on whether citizens can afford it, rather than the ease with which citizens can access it.

Quality healthcare is underpinned by adequate and well-equipped healthcare facilities, as well as the professionalism of healthcare providers delivering services in such facilities.

Therefore, for a government to provide quality healthcare to its citizens it has a moral obligation to provide adequate and well-equipped healthcare facilities and employ the best healthcare providers available. But the SA government seems to believe that enabling citizens to pay for healthcare is the magic wand that will deliver quality healthcare.

The government provides healthcare to its citizens in the form of day clinics and hospitals that provide emergency treatment, immunisations and other such services. But the facilities are generally of low quality, characterised by dilapidated buildings and equipment, a shortage of doctors and uncaring nurses.

Unfortunately, these are utilised mainly by poor people who have no alternative. Logic would dictate that improving the quality of state healthcare that is presently being provided to citizens is the fastest way to provide quality healthcare to all citizens.

Improving access to quality healthcare for the majority of poor people requires adequately equipped facilities manned by proficient healthcare professionals. It is difficult to understand how the quality of healthcare can be improved if the quality of the facilities and staff in poor communities remains below par.

This notion of funding as the solution to quality healthcare provision seems to have been influenced by the existence of privately owned, well-equipped healthcare facilities where healthcare professionals in private practice are able to provide services that are interpreted as being quality healthcare. But this takes place at a huge cost to the consumer. Those with money are able to access quality healthcare because they can afford to pay for it. Medical insurance in the form of medical aids have slotted in, enabling some employed people to be able to access quality private healthcare.  Those able to avoid subjecting themselves to the low-quality healthcare provided by public facilities comprise only about 9% of the population.

The government seems to think quality healthcare for the majority can be achieved by increased funding. But does that mean being able to access private health facilities? Does it mean the 91% who are not medically insured will be medically insured through NHI? Will the private facilities be able to accommodate the extra 91% of the population?

What is the point of mobilising funds to insure everyone, rather than providing quality facilities either for free or for a minimal fee? If the reason private providers are able to offer quality healthcare is top-notch facilities, the government must provide top-notch facilities. If the reason is the best healthcare professionals, it must entice the best healthcare professionals to work in state facilities.

Just imagine how much waste could be averted if state facilities competed toe-to-toe with the private sector.  

Dr Kenosi Mosalakae

Houghton