As the South African government is pressing ahead with the National Health Insurance (NHI) plans, it has been urged by professors not to follow the American model because it’s “not working”.
Minister of Health Aaron Motsoaledi spoke with passion at a South African Medical Association meeting, held at the University of Pretoria, for over one and a half hours to an audience of medical professionals about why NHI was not negotiable, and how plans for its implementation are progressing – and then stayed to field questions for another half hour.
NHI making progress
“We are not going to deviate from the NHI,” he said.
Referring to the widespread belief that ‘nothing is happening’ in terms of readying the system for NHI, the minister said that while “above the water you may see very little, underneath we are paddling furiously”, and he shared some information about the work of assessment that’s been underway for some time.
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This has revealed that some medical facilities around the country are only around 30% viable in terms of medical equipment and physical infrastructure, and we cannot, he underlined, provide quality healthcare for all without first doing the work of building capacity – both bricks and mortar and human resources.
Motsoaledi sketched the global context for NHI. He noted that the move to universal health coverage is taking place in the majority of countries in the world, with the USA and South Africa notable exceptions.
He revealed that he regularly attends an annual function at Harvard Medical School, where professors have urged South Africa not to follow the American model because it’s “not working”.
Spending on health
The USA spends almost 18% of its gross domestic product on health, more than three times the percentage recommended by the World Health Organisation. (South Africa spends 8.5%; only 3.5% of that is in the public sector, the rest is devoted to the 16% of us who use private health care.)
“The American system is the most expensive in the world, but it does not produce results,” he noted. Better outcomes are seen in countries which stick closer to the 5% figure, but draw most of that from mandatory prepaid health care (that is, universal health coverage instead of medical scheme-type cover and cash outlays).
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This move to universal health coverage is seen as the third great ‘transition’ in public health, the first being the demographic transition which took place in the 19th century, revolving around sanitation, hygiene and similar matters and propelling life expectancy forward by leaps and bounds as it filtered into countries across the world.
The second transition was the epidemiological one which saw vaccination, antibiotics and other discoveries reining in infectious diseases and creating another massive shift in public health. This transition is a paradigm shift in the approach to health care financing.
No quick fix
The minister said that it is not something that can be done quickly – he noted that universal health coverage in some European countries had taken half a century and more to develop. He spoke about how Qatar had taken 18 months from initiating universal coverage to implementation, but when he asked how this had been achieved; the response was to point out that the Qatarians had started consulting, thinking and planning in 1991.
We in South Africa are hoping to leapfrog some issues, but still, we cannot expect a short-term implementation, said Motsoaledi.
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