The Portfolio Committee on Health this week brought the public hearings on the National Health Insurance (NHI) to the Free State. The hearings were a continuation of the nationwide public participation process to ensure that the Bill is strengthened and reflective of the views of all South Africans. The Weekly’s Martin Makoni spoke to the chairperson of the committee, Dr Sibongiseni Dhlomo, to get a better understanding of the proposed health system and how it’s set to benefit the people. Excerpts:
How would you define the NHI and what exactly does it seek to achieve?
This is a policy that is actually circulating in the world, championed by the World Health Organisation (WHO) and is aimed at giving universal health coverage. It is proposed that all citizens of the world must have access to health. In South Africa, it has taken the name NHI (National Health Insurance). Other countries like the United Kingdom call it the NHS (National Health Service). So, different countries call it by different names but it still following principles of a universal health coverage. It proposes that those who are working, those who are healthy and those who have resources must put those resources into a pool of funds in order to assist every other citizen of respective countries to access health services irrespective of whether they can afford it or not. The aim is to make health a public good accessed by everybody and not a commodity to be paid for.
How practical is it for this system to be implemented in South Africa given the criticism from some quarters saying this might not be affordable for the country?
I am one of those South Africans who belong to the 16 percent of the population with medical aid. We are benefiting from a cake which is about 4.5 percent of the country’s Gross Domestic Product (GDP) for health. That slice of the cake is actually equivalent to the slice given to the other 84 percent of the population. Now we are saying the NHI must come and equalise that issue. I am heavily subsidised like any other government staff member who is on medical aid. We are subsidised to the tune of R26 billion. So, in terms of where the money for NHI will come from, it’s the same amount of money rearranged. It can’t be that we want to do good to other South Africans and the issue is money. Those who have must be able to give a bit more for those who don’t have. There is money, it’s just a matter of topping up that money from what treasury is going to identify. There is money already, but it’s just not well distributed.
But the people with medical aid are paying for it every month, how does it become an unfair system?
Medical aid is heavily subsidised by government. I get a lion’s share compared to my domestic worker, gardener, my neighbour and even the old woman in the village. Why should it be like that? Why should I be so privileged compared to the rest of the people? So, it calls on the social consciousness of the citizens to say can I open up my space so that what I have can be shared with other people in the same space where I am. That’s the principle of the universal health coverage in the whole world.
What will happen to the R26 billion currently going to private medical health from government when the NHI implemented?
The NHI Bill does not intend to abolish medical aid. It will see the medical aid playing a complementary role. It’s important to note that this Bill is based on a primary health care model. So, if you cough just for one day, you cannot just go and see a specialist in your community. The NHI talks about a referral pattern. You start with your local GP (General Practitioner) or a clinic and get referred up. Currently, it’s like, if I have a medical aid, I can wake up and go see a specialist. That’s why it’s being suggested that medical aid should play a complementary role and all of us as South Africans should contribute to this pool of funds which is going to benefit everyone. But if you then feel that this programme is not meeting your needs and you don’t want to wait to be referred… you want to jump the queue, then you may do so at your own expense but you still have to make a contribution to that larger pool of funds.
Let’s say one has a personal doctor they always consult when not feeling well, does that mean they will be forced to go to the local clinic when NHI comes into effect?
No, that is why the Bill is advocating that when you live here in Mangaung, for example, you need to register so that we know you and your family and we know the population of the area so that you don’t wait in the clinic for long hours. Among other things, we will have to accredit specific hospitals, clinics and general practitioners to be part of the NHI. So, if your GP is accredited to provide services under the NHI, it means that doctor will be required to offer services not just to you, but to that catchment area where you live. And when you go there, you won’t have to pay anything because that doctor will be NHI accredited. NHI will however not allow you just go to a specialist without being referred. It will not pay for that.
Government has been criticised a lot over the years with some people saying it has failed to run the public health service characterised by staff shortages, drug stock-outs and low morale amongst the medical staff; is there capacity to sustain the NHI?
You are correct. As we do public hearings, these issues do come from our people. I call these issues the enablers of the NHI. Yes, the minister must demonstrate their readiness to deal with issues of long queues in hospitals, the shortage of staff, the shortage of medicines and they must also be able to deal with the attitude of staff. There is a programme called the Presidential Health Compact which like a plan indicating their desire to improve on those issues. Of course, until and unless you seem to be making good progress on these pillars of the health system, people are not likely to have confidence in the NHI being the solution. You must show strength and progress on the issues you pointed out.
From the public hearings here in the Free State, what would you say are some of the key issues raised by the people concerning the NHI?
What people are saying to a large extent, is that they support the NHI, but they also have some issues they want clarified. They want to know what will happen to the long queues at clinics and hospitals, the shortage of medication, the shortage of staff, the infrastructure that is not up to scratch, and so forth. We are happy that at the public hearings we have senior officials from the department of health to indicate their readiness and plan to sort out these issues. There are however certain negatives that people are raising: they want to know where the money for the NHI will come from and whether it won’t be just another SOE (State Owned Enterprise) that will require regular bailouts. They are asking whether this won’t be another vehicle used for corrupt purposes… I must point out that President Cyril Ramaphosa launched a programme called the Anti-corruption Health Forum where he is empowering the health minister and his officials to use certain steps to make sure that whoever is appointed, will not be involved in corrupt activities but will actually support this noble cause by looking after the funds for the NHI. So, having a watchdog over the NHI is one of the measures expected to ensure it will run smoothly. There are also some people who don’t support the NHI because they are worried about the potential for corruption and that it will take more money from a very small tax base.
In countries with very effective public health systems, people pay very high taxes to ensure the smooth running of the system, are we likely to see an increase in taxes should the NHI come into effect here?
Once the system is put in place, there will be money allocated for the NHI. What’s needed to begin with is to rearrange the money that is already there in the health sector. Yes, there might be need for more funds because the money must come in to support the process over and above what we already have. But the bottom line is this, we need to choose between you and me putting a bit more money from our pockets and save other people who don’t have anything or leaving things as they are. Right now, those who don’t have just die and nobody looks after them. Those citizens we save today might one day be the judges, pilots or engineers that this country needs.
Lastly, how important is it for people to be attending these public hearings?
We as parliamentarians we are just coordinating a process. Every law making process must be democratic. It is therefore important for every citizen to make a contribution towards the making of this law. We don’t expect everyone to be in support of the Bill, but maybe those different views they hold could be used to enrich what we have on paper right now. It is the duty of every citizen to be part of this process by contributing their diverse views.