Healthcare: The future of NHI will depend on how we shape it

JOHANNESBURG – “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so,” said well-known philosopher, Mark Twain.

What Twain, an American writer, humorist, taught us was that beliefs that are deeply rooted and firmly entrenched are difficult to change without the ability to think critically, and also that when confronted by an opinion, backed-up by facts, which contradicts our own, we have a tendency to double down and retreat even more strongly into our entrenched beliefs.

The truth is at some point in our lives, we all must confront difficult conversations. 

The rationale of the upcoming National Health Insurance (NHI) is a no-brainer. Having medical coverage makes people healthier and enables them to get the care they need when they get sick or injured.

However, when the conversation on the NHI bill remains vague and short on implementation, this produces anxiety, worries and sometimes hostile, combative and responses.

Therefore, to achieve universal coverage for all, we need to think critically, avoid retreating into an entrenched belief and embrace a collaborative approach to achieve a calm, cogent, phased introduction of NHI.

Why do we need achieve a calm, cogent, phased introduction of NHI? Because everyone lives under constant daily stress, worries about getting sick, and about paying the bills if they get sick. 

Statistics published by the Institute of Race Relations have painted a bleak picture. Out of South Africa’s population of more than 57 million people, only 17.4 percent are covered by a South African medical scheme. This means that only 9.5 million South Africans have access to private medical care while more than 44 million don’t.

Of course, health insurance doesn’t prevent terrible things from happening to us. It just makes it easier for us to cope with them when they do, and provides us with the peace of mind associated with knowing that a health emergency won’t destroy us financially. 

Indeed, in the 21st century, access to quality healthcare is a basic human right. It cannot be that hundreds of people die every year, simply because of lack of this access. 

The truth is we currently have universal healthcare. People have the right to make use of a public facilities. What is at stake is the management of the public facilities let alone the quality of care, the infrastructure challenges and resources thereof.

What we need is a workable accommodation between public and private healthcare.

As we brace for the full implementation of NHI in the next years, we need a reminder of what ails our healthcare.

According to the World Health Organisation (WHO), of the numerous maladies, three stand out. First, public healthcare is insufficient in most cases due to resource starvation and inefficient facilities and infrastructure, corruption and poor governance.

Secondly, our private healthcare has become predominantly a private profit business, heavily curative-oriented and prone to excessive pricing.

Thirdly, courtesy of  the WHO research, is the “people aspect” of healthcare. The WHO says: “How people live and take care of their health has been allowed to degenerate; the protective armour of disease prevention has weakened. Nutrition is poor. Rural and urban sanitation is dismal. Consumption of tobacco, alcohol and fast foods, and lack of exercise have become major risk factors causing a mega-epidemic of diseases such as diabetes, cardiac problems and cancers.”

From these reasons of what ails our healthcare, it is not easy to define a roadmap towards a system of universal healthcare that is both of decent quality and that is financially sustainable. 

To meet the needs of the sick and have no access to quality healthcare we must provide integrated, sustainable and innovative solutions across the entire cycle of care.

NHI cannot be implemented by the government or the private sector alone. It will need participation of both, but more important, of the people. 

How much are we willing to invest in helping people live less anxious, more stable lives?

Of course, the bill states that NHI will be funded by a number of taxes – including a new payroll and personal income tax, and the scrapping of medical scheme tax credits.

I believe that only through a collaborative approach, can we get clear details of the contents and action plans of the NHI’s social compact which the public and private sectors can work collectively in meeting the health needs of the population through well-designed and implemented partnerships in the areas of infrastructure funding, service provision and overall health system strengthening.

While it is accepted that there have been challenges with various aspects of private medical aid industry, there are significant lessons and experiences that government can gain from creating a more inclusive process that strategically taps into the skills and expertise in the industry. 

This expertise could include creating an NHI legal framework that allows for a duplicative environment which enables the NHI Fund to offer wider innovative product offerings that medical schemes and health insurers can provide to meet the needs of the population.

For example, we at AfroCentric Group believe details of NHI’s benefit packages and elements of the transitional plan would assist in planning the transformation required of the private sector and provide certainty for employers, employees and scheme members.

We believe that it is possible for a framework to be provided that could allow for the introduction of benefit options that could increase scheme coverage to a third of the population. 

Simultaneously, the national fund could focus on the indigent, infrastructure development and resource planning and we could then align those to have a national system that provides quality care to the country.

We are certain that numerous opportunities will continue to exist for the development, testing and implementation of mutually beneficial and innovative healthcare delivery models and solutions through partnership.

I believe that, regardless of background, we all have a part to play in improving health services and that everyone has a unique contribution to make, willing and able to make major changes that improve and save lives.

Without a shadow of doubt, this is a tall order and one that our society demands we get right. 

The future of healthcare is and will depend on how we shape it.

Ahmed Banderker is the chief executive of  Afrocentric Group. The views expressed here are his own.

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* This story has been selected as study material for the National High Schools Quiz final. For more stories click here.

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