Anger at ‘secrecy’ around national health insurance

2010-08-02 07:54

Government should break the secrecy over the national health insurance (NHI) and give grassroots stakeholders a say in policy formation, academics and activists said at a seminar on the proposed system.

“There is no public engagement in this process, the government has removed itself from public participation in health care,” said Damaris Kiewiets from the Cape Metro Health Forum.

She argued that district health committees had to demand to be funded properly and to be made part of the process because their members truly understood the health care crisis.

The Treatment Action Campaign said it had no idea “what this NHI looks like” and believed government should be confronted with a clear set of demands from people in the field and the public.

Chief among these, TAC representative Lydia Cairncross said, was that the NHI should create a single, free health care system that distanced itself from private health care.

The state should stop subsidising the private system by immediately suspending the tax exemption for medical aid contributions, which cost Treasury between R10 billion and R15 billion rand a year, she said.

“We have to campaign for the health system we want. We want a single system, funded from a single tax base. We should strike the tax subsidy tomorrow. We say we don’t have money but there is R15 billion floating about which we are devoting to the private health care system.”

The one-day seminar, held at the University of Cape Town this weekend, heard a range of views on the future of the private system, ranging from angry calls to nationalise it to a more moderate stance put forward by Cosatu that eventually public and private systems should merge.

One system
“We need one health care system for all our people. If the level of service in the public sector is what it should be, then there will be no need for a private sector based on what we see as profit motivation,” said the labour federation’s Western Cape secretary general Tony Ehrenreich.

He agreed that the tax exemption was “a prejudice to the public purse” but said it was not an answer to dismantle the private health system in the absence of a viable alternative.

David Sanders, the director of the School of Public Health at the University of the Western Cape, said South Africans lived with “a myth that the private health system is great”.

In fact it was inefficient and overpriced and often left medical aid subscribers to pay out of their own pocket as their benefits dried up.

He also voiced concerns about the tax exemption, arguing that there was perception that only the relatively wealthy were taxed while in fact the poor carried a proportionately unfair tax burden because of value added tax.

Sanders said the country’s health crisis would only be resolved if there was a strong social movement informing the government of people’s needs and holding it to account.

“The issue will only be resolved when there is a strong democratic movement that holds government to account,” he told delegates.

Sanders said he believed the state’s plans around NHI were in very early planning stages and probably shrouded in secrecy as a result of fears that leaks would prompt doctors to leave the country.

“There is a lack of transparency ... the discussions are taking place behind very closed doors,” Sanders said.

“I suspect the secrecy is because the private sector has been so antagonistic towards it that the government was worried about the loss of medical care professionals.

The policy is in the hands of the inter-ministerial committee on national health insurance, from where it will go to Cabinet.

Ehrenreich said Cosatu felt sidelined from the policy discussions and planned to raise the issue with government.

“It is of great concern to us. There is a lot of silence around the NHI and consultation has been inadequate from the side of government.”

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