Demystifying the myths about the NHI

Despite rumblings that Cabinet has rejected the NHI Bill, the health department is adamant that "all is well". Picture: iStock
Despite rumblings that Cabinet has rejected the NHI Bill, the health department is adamant that "all is well". Picture: iStock

Finally, the National Health Insurance (NHI), which will grant access to free healthcare to millions of our citizens, is here. But despite the ANC-led government’s great strides in making this possible, the DA is preoccupied with myths circulating about the plan.

Myth #1: ‘Healthcare will be nationalised’

The DA claims that the NHI will “nationalise healthcare”. Nowhere in the NHI Bill, nor in the green and white papers, is the word ‘nationalisation’ used. Instead, the bill says it will purchase services from public and private healthcare providers – which include hospitals, private specialists and general practitioners as well as allied health professionals in private practice. The NHI is not going to do away with private health providers, but it will operate in a completely different environment from the status quo.

  • Firstly, the NHI will not allow health providers to charge the huge fees they do, especially private hospitals.
  • Secondly, a healthcare provider will not be allowed to start treating patients and then send them away once their medical aid funds are exhausted.
  • Thirdly, private ambulance providers will no longer be allowed to pick up only people who have medical aid, credit cards or cash at the scene of an accident and leave behind the poor. Under the current system, a private provider may charge you extra cash over and above what your medical aid has paid it.

Myth #2: ‘We cannot afford NHI; it is too expensive’

It is the current system, in which South Africans spend over R400 billion, that shows signs of unsustainability. Government spends 4.4% of our gross domestic product (GDP) on the health needs of 17% of the population, leaving 83% with a measly 4.1% of the GDP. The World Health Organisation (WHO) and the Organisation for Economic Cooperation and Development (OECD) have declared South Africa to be an outlier as we are the only country to spend so much on a minority of the population – a practice akin to apartheid, differing only by income levels.

The NHI is designed to ensure that existing health resources – funding and human resources – are rationally distributed and shared among all citizens. It will guarantee healthcare to the entire population, based on principles of social solidarity (the rich subsidising the poor), efficiency (reducing waste in the current healthcare funding model) and effectiveness. So, it is not about whether the NHI is affordable, but about making it affordable.

Read: NHI hits and misses

Myth #3: Additional tax burden

To redistribute existing healthcare resources to ensure equity, there will be changes in the way we collect revenue for healthcare. This will include removing user-fees in the NHI-funded services and increasing our taxes, based on the principle of social solidarity. Out-of-pocket expenses will play no role, and medical scheme contributions will need to be reduced as the future role of medical schemes is redefined. The DA plan does not say how it will offset the high cost of out-of-pocket expenses experienced by South Africans who have medical aid or not.

Myth #4: NHI fund will be a ‘state-owned enterprise’

Nowhere is the NHI fund called a state-owned enterprise (SOE). It will operate like a public entity. It will create a single pool of funds for universal health services, enabling the country to have capacity to strategically buy services from public and private health providers, and achieve significant efficiencies. In many countries with single strategic purchasers like the NHI fund, administration costs are below 2% – far lower than medical schemes’ existing costs, which average between 10% and 12%.

Like other SOEs, we are aware that the NHI fund will be vulnerable to corruption, and in debating the bill, we will ensure that it is not only managed with transparency and accountability, but that it also has built-in anti-corruption measures in place, with oversight by our investigative agencies, civil society groups and other agencies. These institutions will establish fraud detection and prevention strategies before a cent is transferred to the NHI fund.

It is time for the DA to stop grandstanding and help the country to build an NHI that we can be proud of.

Munyai is an ANC whip for the parliamentary portfolio committee on health


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