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Nkosinathi Mokoena
 
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The National Health Insurance debate

02 April 2013, 10:01

South Africa is in the process of introducing an innovative system of healthcare financing with far reaching consequences on the health of South Africans. It is not debatable that there is a crisis in our Health care system hence; a change is inevitable.

The ANC National Executive Committee (NEC) 52nd National Conference in Polokwane could be seen as the birth mark of the New Health Insurance policy. NHI is a health insurance that insures a national population for the costs of health care and usually is instituted as a program of healthcare reform. It is enforced by law. It may be administered by the public sector, the private sector or a combination of both. Funding mechanisms vary with the particular program and country.

In South Africa, there are three ways in which this mandate might be funded. (i) Once off tax levy, (ii) the basic payroll and lastly, (iii) increasing the VAT rate.

The introduction of the NHI is mostly contended as a way to fulfil the Constitutional mandate under section 27 (The right to Health Care). At this moment, approximately 16% of South Africans have access to medical aid schemes which leaves the majority of South Africans without medical aid. That on its own it’s a true reflection of the South African socio-economic status.

I think it is very significant to state where I stand in this regard.  My argument is influenced by the Anti-NHI viewpoint.  Again, I think South Africa is bugging the wrong tree. Let’s go back to basics and ponder on the following questions before moving forward. Why do people need health care? Why do people get sick? Where do people get sick? How do they get sick? Our answer to support or not support the NHI is embedded in the response of the Why, How and Where.

Our three spheres of government (national, provincial and local) have failed the public. They have miscarried the mandate to deliver basic needs to such as water, electricity, sanitation etc. The factor of poor sanitation has resulted in many sicknesses or deaths through out the country. Failure to deliver clean water has resulted in the death of 224 people in Kwazulu Natal due to the cholera outbreak. There are innumerable cases where our government has failed to live up to its constitutional obligations.

Does the introduction of NHI resolve the basic problems we have? It would not take a rocket scientist to say NO. The guys who once said “prevention is better than cure” deserve some bells. The focus of the ANC conference was to establish a health system that is accessible to every South African citizen. The problem with this focus is the narrow view point of which is focusing on the solution rather than the real crisis. South African government needs to shift their efforts to the problems that resulted in the Health burden or crisis. What is the significance of attaining a proper health care system if the causes of diseases or sicknesses are not being dealt with? What about the shortages of doctors and nurses in South Africa?

One crucial feature that everyone has been ignoring is the unemployment rate. Our current unemployment rate ranges between 35%-40% of distinct age groups. How does one fund the NHI through taxation if the unemployment rate is so high? Who are you really going to tax if so many people are not working?

South Africa is well known for its decent taxation system in the world but with corruption as a new career path, it is really hard to convince people to put more of their hard earned money to the taxation fund. Can we even trust you about our money? Throughout the South African government structures and substructure, is has been confirmed several times that we have a problem of incapacity and maladministration. What about the crumbling hospitals infrastructures? When is that issue going to be addressed?

In conclusion, the NHI is a good idea and it is what South Africa needs however, we are hurdling and deserting severe problems that we have in this country. We need to start sorting out the basics then we can think of tackling the major ones. We need to address the issue of unemployment in order to increase the number of tax payers. The issue of maladministration needs to be curbed. We are in serious need for an accountable governance structure and proper implementation mandate.

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