Addressing the public-private healthcare divide
The recent passing of South Africa’s National Health Insurance (NHI) Bill has sparked a critical conversation about universal access to quality healthcare.
However, the Bill seems to overlook key considerations from successful models around the world. The ANC’s previous healthcare plans recognised the need for equitable access to healthcare, and attempted to address the private-public healthcare divide through the Medical Schemes Act.
Unfortunately, this led to increased costs and limited accessibility.
The right to healthcare
Section 27 of the Constitution mandates the development of legislation to progressively realise the right to healthcare. In the absence of effective public healthcare, this could be interpreted as access to affordable mechanisms for financial risk transfer, such as insurance. However, the current public healthcare system falls way short in terms of quality.
Health risks are closely tied to poverty, and healthcare access remains inequitable in South Africa. Low-income households cannot afford contributions to regular medical schemes, and attempts to establish Low-Income Medical Schemes have not been successful.
The lack of a viable low-cost medical scheme option, and the restrictions imposed by the Medical Schemes Act, have excluded low-income households from pre-funded quality healthcare. It is worth noting that the majority of outpatient incidents in low-income settings are caused by a small group of conditions. Removing some of the more onerous requirements on medical schemes to provide comprehensive cover could have addressed the urgent healthcare needs of low-income communities.
Community-based health insurance
In fact, community-based health insurance (CBHI) schemes provide a compelling alternative solution. They rely on solidarity and community participation, offering financial protection and improving resource mobilisation and health service utilisation.
The Kisiizi Community Health Insurance Scheme in Uganda is a successful example of CBHI in action.
The quality of public sector healthcare in South Africa is compromised by various challenges, including long waiting times, poor infrastructure, and inadequate disease control practices. The COVID-19 pandemic has further exposed these deficiencies, eroding public trust in the system.
Sustainable funding and effective implementation
Sustainable funding for healthcare is another crucial consideration. The funding needs projected in the NHI White Paper are based on optimistic assumptions about economic growth, and the current tax base is too narrow to support the proposed funding mechanisms. The emigration of taxpayers and the departure of younger individuals exacerbate the funding pressure.
The lack of a clear implementation and funding plan for the NHI raises significant concerns. Critics argue that the bill is unworkable and could face legal challenges. The focus should be on improving health outcomes, but the government is already struggling to manage the existing public healthcare system. Nationalising private healthcare without addressing underlying issues may not improve healthcare standards.
Civil society organisations’ limited outcry regarding the NHI Bill is also disconcerting. It is crucial for business and community entities in South Africa to engage with the government and advocate for a comprehensive review of the bill, incorporating practical and affordable measures to improve healthcare access.
Lucas Greyling is the founder and CEO of Greenraven Ventures (Pty) Ltd), a consulting company focused on improving efficiency in the insurance sector in Africa.
