An opiate, not a cure

2012-03-29 00:00

ATROUBLING development following the Department of Health’s (DoH) release of the Green Paper on a National Health Insurance (NHI) for South Africa relates to the way in which subsequent health-care discourse is so readily channelled to the prospect of the implementation of the proposed system.

The attention that many of the well-known problems in the public-health sector are now receiving, despite having been visible to the eyes of the government for almost two decades, is being branded under the rubric of the NHI.

For example, on March 22, Health Minister Dr Aaron Motsoaledi outlined 10 pilot districts that were identified “for the phased piloting of the National Health insurance due to start on April 1.” Furthermore, in pointing out its intent to improve hospital management, the department released its policy on regulating the management of hospitals (March 2), while strongly invoking the NHI.

These examples are quite simply marks of the government’s blatant use of propaganda in an attempt to sell and further entrench the idea of the NHI in the minds of the public as the ideal remedy to the failing health system. Why is it propaganda? Because the NHI does not exist. Identifying pilot sites for improving the health system are one thing, announcing them in the context of the NHI amounts to a crude political tactic aimed at instilling confidence in a system that is animated only in the form of a Green Paper.

It is not the NHI, or any other theoretical construct in itself, that will change the condition of our health-care system, but ultimately better governance, accountability and greater political will within the DoH. Marketing policy is very different from implementing it and take note: the louder the marketing the more suspicious one ought to be of the actual content of the policy.

Certainly, the result of this semantic play poses the risk of diverting attention away from discussing rational solutions to the actual problems of the health system and conflating real action with the passing of an arguably politically motivated policy proposal. This is particularly troubling as it indicates that the debate around health care is being framed by certain assumptions which are, no doubt, testament to the government’s success in having essentially reframed the health-care debate on its terms.

Rather than to have put forward an intent to improve the health system in unpretentious terms, the government has effectively appropriated the concept of NHI and turned it into something synonymous with the health-care system itself. The World Health Organisation (WHO) has explicitly stated that “it is the combination of institutional arrangements and legislation relating to revenue collection, pooling and purchasing/provision that determines how equitable and efficient a system is rather than the name that is used to describe it”.

In short, the NHI is simply a proposed financing mechanism and should not be conflated with the health system itself. To do so is to attach ideology to the concept and lose sight of rational solutions to the health-care crisis plaguing the country. Indeed, the complexity of the language used to describe the government’s plan is something about which we must all be aware.

As a consequence of deceptive language, the framework in which improvement of the health-care system now gets discussed, particularly in the public domain, has been curtailed and limited to that prescribed by the Green Paper on the NHI. The idea of the health system being an institution that should ultimately service the population in the most effective and efficient way, regardless of how it is done, has been lost.

At this crucial juncture in our history, we should be discussing and debating various ways which might be effective in upgrading the public system and making better use of the private health sector. Instead, we are talking in terms of an all-encompassing policy model, handed down to us by a government department failing in most aspects of its mandate.

If the foundations for the proposed NHI are not laid out clearly in the Green Paper, how can the concept of a NHI even be given consideration? It is almost as if such criticisms are a shallow means of hedging bets against the possibility that the proposal offers nothing but false hope for the regeneration of the health system. The truth is that any policy proposal couched in ideological terms is less about improvement and social development, and more about serving the agenda of those drafting the policy.

If the health-care system is truly to be improved, there needs to be a rethinking as to how we say things and how we listen to what others say. In a world of much talk and little action, saying what one means is as important as doing what one says. The task for civil society in response to the DoH’’s proposal is not to get caught up in the rhetorical whirlwind, but to be aware of the implications of the complex, yet vague and meaningless words and phrases used to describe its intentions.

Proposing the implementation of a national insurance model for improving health care in a Green Paper is to put the cart before the horse. It is therefore urgent that the government’s proposal be taken back to the drawing board, where policy decisions can be deliberated over by all stakeholders devoid of ideological constraints.

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