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Speaking at the Pharmacy Show on April 6, the department of health deputy director-general in charge of National Health Insurance (NHI), Dr Nicholas Crisp, said the department would not back down from implementing the proposed national scheme. He added: “We want everybody in SA to get a good health system.”

If it is true that the department, and Dr Crisp, want South Africans to have access to quality healthcare, it is unlikely that the NHI is the best path to attain such an outcome. It will in effect monopolise the management of all healthcare, private and public, in the hands of the state — an incapable state at that.

The inefficiencies, problems and wastage in public sector facilities have been well documented. There is little reason to believe that simply giving the state more resources and control would resolve these deep structural problems.

That there are problems in the private sector cannot be denied; but again, granting the state access to a huge pot, and increasing bureaucratic and political power over healthcare facilities and personnel, is by no means the best path to increase access and quality of care. The state could do much better work by implementing the recommendations of the Health Market Inquiry.

Were the government to obtain the fiscal muscle necessary to implement a scheme of the size of the NHI, it should know that introducing the system will increase the possibility of cronyism and other forms of corruption. There will be fierce competition between those in government and the private sector to have the most access to the pot of gold. Indeed, the NHI will likely make state capture look paltry by comparison.

The NHI is likely to drive healthcare professionals out of the country and steadily lower the quality of care in the private sector. In the end, the wealthiest of politicians and private citizens will still be able to go overseas for quality healthcare; the vast majority of South Africans will have no option but to “choose” between ever worsening facilities and fewer resources.

Chris Hattingh
Institute of Race Relations

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