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Shared responsibility and private sector involvement are essential if NHI is to be a viable solution

27 February 2024 Reo Botes, Managing Executive at Essential Employee Benefits
Reo Botes

Reo Botes

Our current healthcare system is a study of massive disparity, and there is no doubt that something needs to change to improve the quality of life for millions of South Africans.

The vision of National Health Insurance (NHI) is to deliver equal access to quality healthcare for all citizens – an admirable aim, however, it faces many hurdles if it is to be effectively implemented. Even in developed countries, national health offerings face challenges around access, and they have far more mature models and infrastructure as well as more resources than we do. If the NHI is ever to become a feasible reality that will benefit people rather than cripple our healthcare system further, there needs to be effective partnerships between the private and public healthcare spaces, extensive collaboration, and shared responsibility for the success of the model.

Coexistence is the key
One of the main challenges South Africa faces is a lack of resources, especially in the public sector healthcare space. Infrastructure is in short supply, particularly in rural areas, and the system itself is fragmented. While the theory of the NHI is to pool funds, this will not automatically improve access to quality care, reduce disparities or promote equitable healthcare. If these aims are to be achieved, it is essential that the existing infrastructure within the private sector is used as well, but it cannot simply be nationalised, or it will face the same challenges as the existing public system does.

Public and private healthcare systems need to coexist, like they do with high levels of success in countries like Singapore and Australia. It is imperative to offer people choice, which improves both quality and efficiency. The private sector has resources, skills, and expertise in managing health insurance, which must be leveraged in a hybrid system. This sector will also be able to offer access to specialists and additional services faster, and they have the systems and processes in place to help people get the treatment they need. However, if this is simply slotted on top of the existing system, where will the money come from to supply services? Conversely, if it is a chargeable service and people are already being taxed for the NHI, the gap between those who can afford these services and those who cannot, will grow even wider, worsening the current situation.

Fraught with challenges
The implementation of the NHI is awash with challenges and opens up significant potential for financial mismanagement, nepotism and other issues that are already prevalent in the nation’s public sector. It cannot simply be written into law that the private healthcare sector will no longer be allowed to supply health cover for services paid for by NHI, because this will be to the detriment of all South Africans. There needs to be a balance between public and private sector interests into an equitable pool of services.

Unless sufficient healthcare services are first established in underserved areas, the initiative will fail before it gets off the ground. Funding allocation needs to be directed correctly and there must be robust monitoring systems in place to prevent mismanagement and theft, and to control leakage. Furthermore, service delivery must be closely monitored. The private sector has these systems in place, and they cannot be excluded from the equation. The case for the two sectors to work together is crucial for successful implementation., There also needs to be a strategy to improve working conditions and align income bases for public healthcare workers, otherwise, doctors and healthcare practitioners will continue to leave the country to seek better opportunities overseas. Technology and innovation need to play a role in driving down cost and improving efficiency, as well as in improving access to healthcare, an example being telemedicine and virtual consultations. For this to happen, basic infrastructure concerns need to be addressed.

The reality is that there is a lot of work to do before the NHI can be considered, and government needs to engage not only with the healthcare sector but with South African citizens as well. Feedback needs to be analysed and concerns addressed, and the change needs to be managed properly, otherwise the people with the means to do so may leave the country, eroding the tax pool and further stifling the ability of the NHI to get off the ground. There must be robust discussion and stakeholder engagement, as well as a focus on change management. Inclusivity and engagement from all parties is the only way to ensure the NHI has a potentially positive outcome.

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