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The NHI debate revisited — accurate information and understanding the potential impact are essential

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Dr Olive Shisana is an honorary professor at the University of Cape Town and special adviser to President Cyril Ramaphosa.

On this Universal Health Coverage Day, observed on 12 December, it is fitting to re-evaluate the discourse surrounding the National Health Insurance in South Africa. Previously, I emphasised the evidence suggesting the private sector’s inefficiency and unsustainability in the long run, while advocating for the NHI as a cost-effective solution. In the context of UHC Day, let’s revisit and reframe these arguments.

First, as South Africa joins the community of nations implementing universal health coverage, it’s crucial to dispel misinformation surrounding the NHI. The NHI, classified as a Schedule 3 Public Entity, aligns with reputable entities like the Council for Scientific and Industrial Research and the Medical Research Council. These entities have demonstrated unqualified audits, and the NHI is expected to operate similarly, fulfilling specific economic and social responsibilities mandated by the government.

Contrary to misconceptions, the NHI, as a Schedule 3A entity, won’t lead to the collapse of the private sector. Operating under the Public Finance Management Act, the NHI Fund will accredit both public and private facilities, reimbursing them for services. This ensures that the NHI covers reimbursable services without impeding the private sector’s operation. The inefficiency and unsustainability of the private sector make a compelling case for the NHI.

Read more in Daily Maverick: NCOP passes NHI Bill in face of widespread condemnation by health professionals, business and opposition

Critics argue that the private sector is more efficient, but evidence suggests otherwise. The Health Market Inquiry exposed the private health sector’s lack of competition and efficiency, resulting in exorbitant costs. In contrast, the NHI’s administration costs are expected to be less than 3%. Concerns about the potential collapse of medical schemes under the NHI are unfounded, as the NHI aims to offer year-round coverage at a reduced cost, addressing the failures of the current system.

Addressing concerns about healthcare quality, the NHI emphasises certification and accreditation standards. By linking reimbursement to certification, the NHI incentivises establishments to enhance compliance and improve service quality, benefiting both the public and private sectors.

Read more in Daily Maverick: The NHI debate is throwing up misconceptions – here are the facts

Acknowledging the historical context of apartheid policies contributing to healthcare challenges, the NHI aims to rectify disparities in access. Despite claims of insufficient funds, other countries with fewer economic resources have successfully implemented NHI. The key lies in optimising resource allocation to ensure effective NHI implementation and improved healthcare access for all South Africans.

Resistance from health professionals and medical scheme administrators is not new, but similar challenges were overcome when introducing national health services elsewhere. 

In conclusion, focusing on accurate information and understanding the NHI’s potential impact are essential. As a Schedule 3 Public Entity, the NHI operates within a robust framework, and the evidence suggests it provides a sustainable and cost-effective solution for South Africa’s healthcare transformation. DM

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Comments - Please in order to comment.

  • Heinrich Holt says:

    And I believe in Father Christmas and that the earth is flat.

  • Ben Harper says:

    Codswallop

    Shame on you UCT

  • Paul T says:

    Hmm, sorry but I don’t trust the government to do anything properly, as demonstrated by the state failing to manage existing state healthcare, the post office, railways, SAA, Denel, the ports Eskom or anything it touches. In the hands of a competent government yes, this one, no.

  • Martin Neethling says:

    Articles like this have a thin veneer of credibility, but are too readily accepted at face value. What is this ‘evidence’ that suggests that the private healthcare system is inefficient and unsustainable in the long run? What are the countries with fewer economic resources that have successfully implemented NHI? We need more than some vague ‘expected’ view on admin costs. Basically Shisana is an ideologue that sees only what she wants to see, and palms this off as fact. It’s part of a well oiled pro-NHI PR campaign, that glosses over I) the absolute capability failure in the current state-funded healthcare system that includes some of SA’s most famous and well equipped teaching hospitals, and II) that no country in the world has banned private healthcare provision, yet this is what the bill proposes. Revisiting this ‘debate’ indeed means that we need ALL the facts on the table.

    • Brett Redelinghuys says:

      100% spot on. Thanks

    • Gretha Erasmus says:

      Thank you for some good points raised.

      I would also like to know from Ms Shisana which are these countries with similar economies to ours that have a Single Payer version of NHI? (apart from Cuba that is, which is a communist country with little regard to human rights, who were able to contain HIV by forcing all HIV positive people to live in a locked institution for years and years, so you can’t actually use them comparison) So apart from Cuba, please name the country that has a Single Payer NHI system with no private health insurance/private medical aid. Basically all low or middle income countries with universal health care has a multi payer system with NHI and private insurance, with more or fewer private insurances depending on the country. Nobody is disputing that a better universal health care system is needed. Many people are disputing the single payer ( single massive government controlled fund with no private insurance) that the government wants to force on everyone.

  • Dave Gould says:

    Some great thinking Olive, so you feel that where government has failed (often dismally) in every area of service provision, this is one you will get right. Why is that ? Also, if you or your family is not well, do you go to a public facility, or one of those nasty capitalist private facilities that are so inefficient?

  • Miles Japhet says:

    If the ANC had actually managed anything effectively without widespread corruption, there might just be an argument. A better perspective is that consumers use their own hard earned money to exercise choice.
    Communist ideology has destructive outcomes, especially for the poor.

  • Bick Nee says:

    This is an incredibly simplistic response to an incredibly complex issue.

  • Veronica Baxter says:

    I think the bottom line is more to do with retaining excellent medical practitioners. If their livelihoods are compromised then they move where their skills are rewarded and they can live safely and have the lights on. As will tax paying citizens who are afraid that their families will suffer greatly. I want our citizens to experience the same level of care that I have received in the private system, but as Tim Cohen suggests elsewhere, the proposed NHI will not make this possible, but potentially reduce care and raise taxes for an already squeezed tax base. The current public sector facilities, especially out of cities, are brutal, despite the best efforts of individuals. The two sectors need to learn from each other and make choices that benefit the citizens of the country, retain and grow professionals who aspire to serve the greater good. Not at the expense of excellent care, not that will bleed us all dry, not for the back pockets, not the tenderpreneurs, nor the stuffed couches.

  • David van der Want says:

    The Public finance management act – Certainly there’s been a lot of acting around the management of public finances – imagine the venal feeding frenzy around all that health money.

  • John P says:

    Communist rubbish from beginning to end. The ANC government has had almost 30 years to build and improve an efficient and functional healthcare system for all. Instead we have gone backwards just as we have with every SOE in this country.

    The ANC answer is not to improve facilities but rather to break them down to the lowest common denominator.

    • Brian H says:

      That’s exactly right. The ANC have zero interest in even trying to make a health-care system like NHI work. All they want is to have a central pot of money…. so that they can steal every last cent. That is their only objective here, to steal.

    • Denise Smit says:

      She has been at it since before 1994. As an ANC/EFF deployee their ideology remains their compass in spite of all the failures they have caused in all aspects of this country’s being. We are a failing state because of all this socialist/communist practices

  • Fanie Rajesh Ngabiso says:

    Forget the detail. There is only one point worth understanding:

    Because this ANC givernment is both useless and corrupt nothing good will ever come from any project it runs.

  • Pierre Schutz says:

    Well that is a pretty pointless opinion piece with approximately zero substance.

    Within a robust framework. #really!

  • D'Esprit Dan says:

    Dr Shisana, with respect, you haven’t provided one shred of evidence that NHI will work, in a culture of unfettered corruption in government circles. You mention the CSIR and MRC as evidence of how the NHI will be untainted, but the reality is that when the numbers are looked at – the CSIR has a total annual income of R2.8bn a year, and the MRC a budget of R225 million, as compared to the minimum of R500Bn that will need to be found from somewhere (and you don’t even get to this topic, because, well, government has no idea where the money will come from, certainly not before an election anyway).

    So these organisations have a combined annual spend (roughly) of what NHI would dole out in 2 days! Given that this newspaper reported in May this year that the SIU had flagged over R8.8bn in corrupt contracts during the Covid pandemic (56.3% of all Covid related contracts), it means the annual income/budgets of the two institutions you cite are roughly 33% of what was stolen in our greatest health crisis in decades in a couple of months. Anyone gone to prison for that yet?

    The simple facts are that the ANC will not admit the unsustainable costs (before corruption kills it off) because this is a desperate stunt, littered with apartheid references to close down debate, when it is clear, given the ANC’s track record in destroying our ports, rail, roads, airlines, education, water, electricity and – PUBLIC HEALTHCARE – that it cannot be trusted to run NHI, ever.

    • D'Esprit Dan says:

      Just to conclude: the private healthcare system, which may be inefficient and costly, was not responsible for Life Esidimeni, the brutal slaying of Babita Deokoran for exposing massive corruption at Tembisa Hospital, the collapse of infrastructure and services at Helen Joseph, Bara and other state owned hospitals in Gauteng and most of the rest of the country: the ANC and its corruption and cadre deployment are fully and solely responsible for this, after 30 years in power and refusing to deliver basic, decent services to the population. Google ‘Gauteng Health Department Scandals’ and see how many articles come up – including one headline saying “Gauteng Health Department has an Eskom level of corruption”. And you want them in charge of R800bn or so of procurement? What a joke!

      • Paddy Ross says:

        As a person of an advanced age, I have had a number of encounters with healthcare issues in the private sector since moving to South Africa seventeen years ago. It is costly but far less costly than the private sector in the UK, in which I worked part-time as a surgeonas well as in the NHS. As to efficiency, I have been hugely impressed with the healthcare that I have received in my time here. So where the accusations of ‘inefficiency’ arise I do not know.

      • Brett Redelinghuys says:

        Dee, you are 100% on target here. Wish it was mandatory to reply in public when you write articles like this. If she could answer you, she would have to withdraw….

      • Gretha Erasmus says:

        Very well said

  • Alan Watkins says:

    The writer refers to
    ” to re-evaluate the discourse surrounding the NHI”.
    ” the evidence suggesting the private sector’s inefficiency and unsustainability in the long run”
    ” while advocating for the NHI as a cost-effective solution”
    ” let’s revisit and reframe these arguments.”
    “In conclusion, focusing on accurate information and understanding the NHI’s potential impact are essential”

    And then delivers nor explains any of this, let alone providing evidence. If this the best argument that the honorary professor can produce, she should be stripped of her position and her degrees.

  • Karl Sittlinger says:

    This is basically just a cheap ploy by the ANC to get votes after failing literally everything else they have touched, at the expense of all in this country that are not cadres or the criminals they protect. I generally refrain from ad hominem attacks, but you (Olive Shisana) should be ashamed of yourself for peddling misinformation the way you have in this article (and other articles before this). Something tells me that neither you nor any of your family have been inside a government hospital in the last 10 years for any health issue, and that you current yourself are on some form of medical aid even as you write this. Universal healthcare, yes, NHI by the ANC, God help us!

  • Rod H MacLeod says:

    Disingenuous – the Healthcare Market Inquiry report does not support your contentions. In fact, the report suggested a management/regulatory body INDEPENDENT OF GOVERNMENT. The fact you can’t understand the issue of independence means you have no idea at all what the HMI report had to say on the matter of healthcare in this country, including its focus on the GOVERNMENT’s FAILURE.

    The matter of the ultimately predictable failure of the NHI is simple. If you have 3 million people paying into a medical stokvel, and you introduce 55 million non-paying members, the delivery of the stokvel to members becomes astoundingly diluted. The 3 million will ultimately seek another solution, and the 55 million will receive exactly what they received prior to the NHI, except now you will have an extra administration burden to finance.

    • Sathyam D says:

      Exactly, the root cause of South Africas failure is the lack of employment in outlying areas, a blatant refusal to deal with our massive unemployed population and no clear plans on how to bring rural areas out of the dirt. The only way forward is through education and innovation which is something the NHI and the ANC are standing in the way of.

  • D'Esprit Dan says:

    I think the best way to understand the ANC’s obsession with the NHI is to understand what the ANC actually is: the world’s largest Ponzi scheme. From branches to the Presidency, advancement is through patronage, and patronage requires resources that have to come from the public purse. The ANC has run many of these Ponzi schemes to keep renewing its membership and keep cadres past, present and future in line: Eskom, SAA, Transnet, water and sanitation infrastructure, public education, public healthcare, and pretty much everything else that isn’t bolted down (and sometimes that as well). Every Ponzi scheme eventually runs out of money, as all the above have, so you need to keep reinventing them, revitalising them, and coming up with new Ponzi schemes, except in this case, those duped are not willing investors with the wool being pulled over their eyes – they’re us taxpayers who have no choice but to keep feeding the beast of corruption. The NHI is the latest, grandest Ponzi scheme, especially since Zuma’s nuclear deal went belly up (until this week’s announcement) and the Karpowerships are going nowhere: the urgency around NHI is about the elections, but largely in the context of needing to keep the Ponzi scheme afloat.

  • Vas K says:

    By all means, do your quaint little analyses and discussions, just do not lose the sight of the basics: The ANC Mafia NEVER comes up with any schemes or ideas which would benefit the citizens of South Africa. Be it NHI or the endless billions thrown at the SOE’s and “organisations” like SAPO and many others, they have only one purpose: to create pools of money for The Mafia’s cadres to steal with impunity. The greed is endless but the money is running out left, right and centre.

  • JOHN TOWNSEND says:

    She is employed at UCT so I am sure she is on their Private Med Aid. Come on DM, contact her to confirm if this is the case.

  • Cape Doctor says:

    As an alumnus and ex-senior lecturer at UCT, I am rather embarrassed by this vacuous little slice of propaganda (apparently) authored by a high-ranking academic at my alma mater. I remember a time when sweeping statements unbacked by reliable data got you laughed out of meetings and shunned by journals. Has the world changed that much since then? Or is it just UCT?

  • David C says:

    “Shame on you, Ms Shisana. Absolute ideological clap-trap nonsense pedalled to ensure you keep your teeny little space at the increasingly bare trough. When you mention medical inflation in the Private sector, how about you mention that the Private Sector, from pharmaceutical companies to medical service providers to Medical Aids ALL currently subsidise the Public sector facilities in one way or another? A simple example: a cancer drug that is provided to the Public sector at below cost prices, is charged to the Private sector at 14x the price, so that the Pharma company can recover the loss of earnings.
    And, anyway, the costs in the Private Sector argument is a complete red herring: compare the medical outcomes in the 2 sectors and then publish the results. Also publish the comparison between Medicolegal claims in the Public sector vs the Private sector.

  • Gerrit Marais says:

    Absolute drivel and just grateful my kids left university some time ago.
    What I also do not understand is why access to UHC is given so much prominence when hunger is a growing disaster in this country. And finally: so anyone can have as many children as they wish and the taxpayer must just fork up. Free housing, health, education and some grants as a bonus.

  • You Can Not Be Serious! says:

    Before the government screws up another industry can all politians and everyone working for government be limited to only government medical institutions/facilities. It’s laughable that you think the public sector is more efficient. The fact that most government employees do not use public facilities makes your assertion a joke. After 10 years of all government employees and politicians using public institutions we can talk again about NHI. They will soon fix public medical facilities once they are subject to it. A similar law should be passed on Education. All politicians and government employees must only send their kids to government schools. Again they will improve overnight.

    The headline article caught my eye and I thought perhaps there is a perspective I am missing. Only to read absolute nonsense!

    Daily Maverick I’m seriously concerned about the quality of your articles. I have never read such a wildly inaccurate article. If Mrs Shisana is a special adviser to the President, we are in more trouble than I previously thought.

    UCT how does one go about getting an Honorary Professorship? My two year old son is available.

  • John Strydom says:

    Recently experienced two friends going through the private system: pretty efficient on the whole, but the costs were staggering – amounts that could bankrupt a family.

    • Johan D says:

      NHI will let both your friends die and bankrupt the country 🙂

      Magic solutions doesn’t exist. But people in government doesn’t believe in hard work and incremental transformation.

  • George Watson says:

    “The NHI’s costs are expected to be less than 3%” 3% of what? If you look at the NHS in the UK, a wealthy country by our standards, it is currently collapsing under the weight of increasing demand from increasing population and longer life expectancy and a vast bureaucracy and no government there has the money to fix it, and increasingly people are moving to private medical schemes because the service is deteriorating. There are already “government” hospitals in SA and “government” clinics and the idea that you can increase the quality of those without a vast amount of money is a fantasy and the idea that you can increase the quality other than by taking away from the private system is a lie. The SA govt is already the largest employer in the country and this NHI is a recipe for greater mal administration. There is no doubt that access to healthcare has to be improved but doing this with such a small tax base is a non starter. Far better that people stop wasting money and stealing money and focus on an increasing health budget to repair and expand the govt system while at the same time making access to the private system more affordable to all employees and employers

  • Michele Rivarola says:

    Was this lady not the Health DG in the times when Dr Garlick was punting beetroots and the african potato as cures for HIV (probably on the par with taking a shower). And as for the DoH being an efficient provider of health care perhaps she should first articulate why ministers and her mob of acolytes chose to use the private sector doctors and private sector hospitals ahead of the public offerings if the public offering is so incredibly efficient. We are beyond being capable of being saved notwithstanding the political rhetoric a few months of election time.

  • Geoff Coles says:

    Olive, are you that much bought and paid for?

    • Gretha Erasmus says:

      To be fair to Ms Shisana, I believe she truly believes in the magical system she is promoting. She has punting NHI in this format for over 15 years and will not be swayed by anyone, nor by the struggling economy and fewer tax payers, nor by academics and medical associations input. She was trained in the old USSR and the communist thinking has left an indelible impact on her. Of course when she was studying in the USSR she was a guest of the communist party and never had to struggle for anything like the normal citizens would have had to, and since the she has been employed as a cadre of the ANC, always salaried, she probably has government housing too, where water and electricity issues get sorted by the department of public works. So she has never had to live through the consequences of her ideology. I find one of the biggest issues is that our parliamentarians don’t have to experience the consequences of their poor decisions. They are on Parmed, which pays 500% medical aid rates, all their housing and maintenance gets sorted, they get a salary every month and only have to sort themselves for dinner because breakfast and lunch is also on the state. So they live in this ideological bubble where one can make disastrous decisions that sound nice because even if Parmed is destroyed they will go to Russia or Singapore for healthcare as parliamentarians or other high ranking government officials.

  • Johan D says:

    We already have two examples where government covers Healthcare from the public purse. Road Accident Fund and Compensation Fund. Both are disasters. Why would NHI be magically different than all the other similar things the government runs? And where will they source the magic money to pay for all of this? And the magic doctors to serve all these people? Maybe they should start focusing on training enough doctors first before making policy that will sink this country.

  • ak47.king ak47.king says:

    I think I just saw a pig fly past when I read this article. Utter BS. She has no data to back up any of her statements whatsoever and most are outright lies (or selective bias).
    The GEMS medical aid for government employees is one of the best restricted medical aids to belong to with benefits that out way almost any other medical aid in South Africa. It also has the largest number of members for a restricted medical aid and it is us taxpayers that are paying for it. Why are government employees not forced to use public hospitals and healthcare? Are they going to give up their medical aid benefits for the NHI? I highly doubt it. All the universities have their own restricted medical aids as well, so we know she has never stepped inside a public hospital before.
    As regards to UCT and its standards these days you only have to look at the recent issues it has had with its VC, Council etc. to know how low it has stooped and now has no backbone to speak of these days.

  • Jon Quirk says:

    Ms Sishana appears to be very muddle-headed, and to want to face both ways, at the same time. Consider this sentence from the article. She says,

    “Operating under the Public Finance Management Act, the NHI Fund will accredit both public and private facilities, reimbursing them for services. This ensures that the NHI covers reimbursable services without impeding the private sector’s operation.”

    What this appears to be saying is that access to private facilities, will be controlled by an independent, Government-managed, and that this fund will re-imburse, whom exactly is not clear, for services provided.

    So at a stroke, there is a further layer of bureaucracy, and further, given that both private and public NHI “members” have access, it is entirely possible that the patients who actually fund these service providers and hospitals, will be just another “member” in the queue, and presumably required to wait in line like everyone else.

    It must be born in mind that private patients belonging to each scheme, already, fully fund their own required medical services, but also pay over 90% of the funds behind the public medical services, as these private members are almost certainly the largest tax-payers.

  • Confucious Says says:

    Here’s an accurate picture: Take one of the best private healthcare systems in the world and completely ruin is because you have already destroyed the existing public healthcare system… that was actually pretty good when the government inherited it. Anc mantra is to bring everyone down rather than lift people up. Why not fix what they have? It can’t and must not be an option. Ideological politics is very dangerous especially in desperate hands.

    • Karl Sittlinger says:

      “Why not fix what they have?”

      Because then the ANC would have actually stop robbing the country blind and face accountability. We can’t have that now can we.

  • Vincent Britz says:

    Really?? Do you actually believe that spam that you just wrote and published?? Do you really think for one moment that the ANC government won’t steal or loot the NHI?? Do you really think that the corrupt ANC government can manage something so big and important?? They have been failing at everything!!!

    • Gerhard Vermaak says:

      The pure fact that she is a special adviser for CR already puts this article at risk of being biased, do you honestly think she will write something that will put the anc in a bad light!

  • Colin Braude says:

    “The inefficiency and unsustainability of the private sector”
    Does this cadre not realise that if any private sector entities really are inefficient and unsustainable they go insolvent, (unless bailed out by government like SAA, Eskom, etc)

    More importantly they parasite omits to question or explain why the existing national health system cannot provide universal health coverage (spoiler alert: ANC looting and lack of accountability).

    There seems to be a competition between Doctors Shisana and Crisp as to who can sprout the most rubbish in favour of the ANC’s new looting scheme.

  • robby 77 says:

    Ay yay, this is all so misguided and naive. DM you are either being very charitable to the author for publishing her piece or you are giving her enough rope to strangle her reputation.
    Who expects the NHI to be run like the CSIR, the same misguided government?
    I might agree that the public sector is more efficient, but probably only in the areas of wasteful expenditure and misappropriation of funds.
    And to break two more points down from the article:
    “Despite claims of insufficient funds, other countries with fewer economic resources have successfully implemented NHI.” – a terrible argument. Those countries may be more efficient at using those funds. SA cannot be compared to others.
    “Resistance from health professionals and medical scheme administrators is not new, but similar challenges were overcome when introducing national health services elsewhere” – oh well that’s alright then. No problem in chasing away your primary resource, even if other countries have resistance. Can we afford to lose medical professionals. Easy come easy go hey Prof.

    • Gretha Erasmus says:

      I would really like to be educated on these countries with fewer resources, with a NHI like the current bill.
      Daily Maverick, please give us a breakdown of these countries Ms Shisana notes. Let her name them and explain their systems. Maybe there is something we can learn from that exercise. Because right now it is just smoke and mirrors with no evidence.

  • Francois van der Westhuizen says:

    My biggest concern is that this person is a “Special Advisor” to CR!! All hope is lost!

  • Mark Human says:

    A big fuss is often made about the inefficiency and unsustainability of our Private sector. By what measures are those two are defined? I challenge anyone from the DOH to provide facts and figures here!
    Granted, the costs in the private sector are high yet they still compare extremely favourably with international norms.
    Numerous excellent recommendations, NONE OF THEM IMPLEMENTED YET, were made by the Health Market Inquiry, amounting to yet another multimillion Rand governmental waste of money!
    Of course part of the problem is the exercise of trying to compare costs between the government and Private sectors.
    Tender misappropriation and sheer blatant fraud have resulted in MANY things costing the government sectors MORE than the cost the Private Sector.
    From a cost containment point of view Discovery could teach the DOH many, many valuable lessons.
    The real truth is that our government sector has no idea what actual inpatient treatments costs, because their “hotel facility” is gifted free of charge to them.
    “Efficiency” in the government sector should be properly measured to enable an effective comparison. A perfect example is the sheer quantum of patients lying for weeks in government facilities awaiting emergency procedures… gross mismanagement!
    Resistance from health professionals: most just want to be able to do what they do in the most efficient way possible. They do not want to have to deal with the catastrophe that is many of the government facilities.

  • Brett Redelinghuys says:

    Please. Come down from the ivory tower where you are paid an enormous salary to write this type of unworkable , sit on committees and have working lunches….
    1/ Show us how and why the existing NHI has not worked.
    2/ Give a detailed ACTION PLAN as to how you will fund and implement NHI.
    3/ EXPLAIN (by responding with details) why the reports detailing costs estimates etc are FALSE (point for point).
    4/ Lastly, explain to us lesser mortals, how throwing more money at a leaking bucket will help us and not line the pockets of your technocrat party cadres. Pls use examples like Digital Vibes, Life Estameni etc as reference.
    Or…Don’t.
    Then carry on drawing your fat salary and telling everyone how this has emancipated the average south african….

  • Jo Badenhorst says:

    Oh PLEASE PLEASE PLEASE get real, Olive! Another state-owned opportunity to LOOT the coffers! Are you blind, or what???????

  • Roelf Pretorius says:

    This is evidently an attempt at making the propaganda of the ANC look like objective facts. Not that I am against the concept of the NHI – I am very much in favour of it. But it HAS to work in practice, not like what happened to Eskom, Prasa, the post office, Transnet, SAA . . . and every other enterprise that the ANC has laid its’ hands on. It does not matter how much the Presidents’ advisors like to spin it, this is not about the ANC, but about the people of the country. And it is not just the government that has to plan ahead; those who currently belong to medical funds have to do their financial planning too. For that the government must explain the funding structure of the NHI IN DETAIL, and in a way that the normal man in the street understands, and in what way it is going to differ from what it is now. For instance, it does not help to pretend that the private medical funds are not going to collapse. Of course they are; they are going to be replaced by the NHI, contrary to the propaganda that Olive came forward with in the article. So what is the funding structure of the NHI going to be? Different medical funds have different funding structures, so how much are we going to have to pay? Or is the medical scheme contributions going to be changed to a form of tax? The government has to be more transparent about this, and the fact that they are not, makes one suspicious that something dishonest is going on. I need to know if I am going to have to pay more or less.

    • Gretha Erasmus says:

      You will have a percentage of your payroll deducted for NHI, meaning the higher salaried will pay more, then there will also be a VAT hike and increased personal tax to fund it. They will Lilley use SARS to collect it. Then for that considerable percentage of your income you will get the same healthcare as when you go to Charlotte Maxeke Johannesburg Academic Hospital today. Because the problem in government healthcare is not money per se. It is complete disorganisation, cadre deployment, rampant over charging and on occasion theft, as well as ridiculouslu high legal bills. Since the same goveremt will now administer a much larger fund we will see much of the same. For a few years they will buy services from private at rates the government will decide, but because they pay vendors late, and they will set the price (without regard to the input cost of running a private hospital or a private practice) and very soon the private hospitals will resemble the government hospitals. The plan is to give everyone the same poor standard of health care, but to force the richer citizens (remember it is not voluntary after tax expenditure) to pay much more for the privilege of getting the same poor standard of healthcare than those who do not pay for it (apart from through VAT). Those very few who can still afford it after extra payroll tax , and then still want some health care may even take up international health insurance to go to Namibia or probably even Swaziland by that time

  • Thinker and Doer says:

    Ms Tshisana, your article fails to address the fact that regardless of whether the NHI is listed as a Schwdulw 3 entity under the PFMA, it will inevitably be a magnet for corruption and looting, as has been seen with other public entities listed under the PFMA, including Eskom, Transnet, and SAA, among notable examples. You also fail to address the inability of government to manage such a complex programme, the shambles of the RAF, the UIF, the Compensation Fund, and NFSAS highlight this, and the NHI will be on a vastly more complex and massive scale. The current plummeting state of the public health sector attests to this. There is a failure to recognise, consistent in government statements supporting the NHI, to recognise the extent of corruption and maladministration in the sector. Regarding quality of health care, the pilot projects that were supposed to bring public facilities up to standard were a complete failure. Very few if any public facilities will meet the standards for NHI. There is a failure to address how the NHI will be paid for, and how it can be afforded in the current severe financial situation that the country is in, with so many serious issues to face. This is reckless and unacceptable by government.
    The NHI will not operate under a robust, sustainable and cost effective framework, quite the opposite. The NHI must be legally challenged to stop the complete collapse of the health system, and a proper, phased reform of the health system must be developed.

  • Prasid Mool says:

    When corporate greed affects public services as with health insurance & excludes the majority, it calls for CENTRALIZATION of power and authority. The high costs and greed amongst all in the industry is what has played into centralists in taking control.

    • William Stucke says:

      Oh, dear, Prasid, you are confused. What corporate greed are you talking about? Don’t you know that ALL Medical Aids in RSA are non-profit entities?

      As for the discredited Marxist philosophy that you espouse, please explain why Cubans are so desperate to leave their communist “paradise” that they risk their lives on small boats?

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