The definition of
insanity is doing the same thing over and over again and expecting a different result
each time. – (Allegedly) Albert Einstein
I’ve always wondered what really
goes on in the mind of the South African politician. The blatantly senseless introduction
of a National Health Policy which has been proven to be a complete failure during its Pilot phase, has given the (progress) naysayers enough political fodder
to denigrate the ANC government until the next National elections.
While some would rubber-stamp the
policy as an instrument for achieving equality in the healthcare sector, others
see it as a waste of money and resources at a crucial time when the Government
really don’t need to undertake additional senseless expenditure, suffice it to
say, from non-existent funding. Given
the state of our healthcare system, I would agree with the latter group. The NHI policy may have really good
intentions and may be a ground-breaking piece of legislation in the history of our
young democracy, but sadly the Bill is lacking in crucial detail and the timing
is questionable.
The Public Healthscare
Phenomenon
The Public Healthcare system is
grossly underfunded and understaffed. The Health Facilities are old and
dilapidated. Hospital and clinic Infrastructure is falling apart. Employee morale
is all but non-existent. The cold stares
and subtle, sorry, blatant verbal aggression from staff would leave
one with additional psychological scars after visiting a health facility. Anyone
who has had the unfortunate experience of visiting a day clinic or a public
hospital would know that their day is basically fucked, and they should know to
pack a picnic basket and a blanket (in winter, one may as well sit outside in
the cold, rain). The average time spent in a clinic for an average patient is
nothing less than 4 to 5 hours, with moerse (sic) long queues starting long before the clinic or hospital doors
open. It’s not enough that more than 80% of the population is subjected to such
psychological torture, that they still have to endure the wrath of incompetent Health
“Professionals”.
Most day clinics are staffed with
a bunch of Interns let loose from their Academic Institutions to use the sickly
poor as their lab rats. Whether diagnosis and prognosis are sound is neither
here nor there. Their efficiency is measured by the number of times a patient may
return for the same symptoms. The number of qualified doctors and specialists in
the Public Health System are comparable to extinct animals. You just don’t find
them as freely as you would find one in the private sector. But, can one blame
these guardians of the welfare of the population? What with working long hours
for a tenth of the remuneration his fellow professionals would get in the private
sector. The lack of available resources and equipment to carry out his
profession effectively, and the threat of crumbling infrastructure is enough to
drive any healthcare public servant into the private sector, or as is the
current trend, to greener pastures over there.
Then there are the various hospital
tragedies where hundreds of patients died from blatant neglect and corruption…….maybe
I’ll discuss that on another day when I’m not sick to my stomach of just
thinking about it. As a result, the National Department of Health is facing an
array of Lawsuits which is being paid for by Government Funds meant for the
delivery of Healthcare services; one innovative way to kill off more of the
poor and poverty stricken, and so the cycle continues.
The Sound of Music
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Source : Gstatic.com |
Conversely, the Private
Healthcare system is purring along quite nicely with enough Surplus Funds to
buy out the Public system. Any Private medical aid scheme that claims they are
not making a profit, are only comparing their bottom line to the previous year,
because they didn’t meet their target of increasing profits by another 20% (A
bit of a stretch , but you get my drift).
Compared to heath facilities in
the Public sector, when you walk into a private GP Consultation room or hospital,
you’re greeted with lots of smiling faces and a Doctor whose behaviour and “Professionalism”
can be compared to nothing less than saintly; it’s like walking into a scene
from the movie, The Sound of Music. You’re
pampered and spoiled with air-conditioning in summer and heating in winter,
complimentary reading material that is three years old and other small titbits
of insignificance. But you KNOW in the back of their minds they’re relishing at
the fact that they’re going to screw your medical aid, and go about it “Professionally”.
As a private medical aid member
for the better part of 30 years, I took this privilege for granted and used and
abused it to the best of my feigned health fragility (I was justified, given
the huge chunk taken out of my salary every month). Yet, most times, the total yearly
cost of my family’s medical expenses NEVER exceeded the yearly contributions.
At times I wanted to level the playing fields by living a grossly unhealthy
lifestyle, subject my family to the same, and hope, by way of more medical
expenses, I would get my money’s worth. But these fuckers are tricky; they have
this very cool “incentive”, called the medical savings account, where you as
the ignorant member fall for the trick of having additional funds for
emergencies or extraordinary medical expenses, although you are already paying
almost 10% of your salary to cover those very expenses. When you eventually realise
you’re being screwed, they’ve already taken the balance of your “savings”, which
would be protected by a clause that says it cannot be carried forward (you
know, like an accounting transaction) to the next year. But I digress.
The Private Healthcare system
services just under 20% of the South African Population but accounts for 50% of
the total National healthcare budget. The patient-to-doctor ratio is six times
higher in the Public Sector compared to the Private sector. Over the last 10
years private hospitals have increased their tariffs by almost double the rate
of inflation, hence the huge profits enjoyed by the biggest 3 Hospital Groups,
i.e. Netcare, Life Healthcare and Mediclinic, with Discovery Health coining it
in the medical scheme segment. The Private Healthcare system in South Africa is
such a monumental money making machine, that International investors are falling
over their feet to buy into it. Yet the 20% of South Africans using Private
Medical care is none the wiser as to how they’re being ripped off in broad
daylight.
The huge profits made in the
Private Healthcare System are mainly attributed to:
- Higher than inflation membership scheme contribution increases
- Higher than inflation tariffs and other Hospital
charges
- Disproportionate distribution of benefits per medical plan
- Higher percentages of contributions going to
non-healthcare costs
- A lack of Competition in the Hospital and Medical
Scheme markets
- Member and Consumer apathy in relation to Scheme
plans and Medical jargon
- A lack of measurement data to assess Quality Healthcare
from really bad Healthcare; (except between
Public and Private Sectors, but not within the Private sector)
National Health
Insurance for Dummies
So, now that we know the Public
Health system is fucked beyond comparison, and the Private Healthcare system is
rolling in billions from ripping off the Middle class, how would the NHI bridge
this huge gap in equality? To answer this, here are a few thoughts which our
esteemed Minister of Health, Dr Zweli “NHI will be implemented whether you like it or not” Mkhize has to offer.
Firstly, as mentioned the primary
goal of the NHI is to bring quality, affordable Healthcare to every South
African citizen, and to reduce the high cost of private healthcare. Suffice it
to say that the access to free healthcare should be a Constitutional right,
because after all, a healthy populace would ensure a healthy workforce, not so?
If so many European and Latin American countries can do it, it shouldn’t be
that much of a challenge? Right?
According to the National
Treasury, the cost of the NHI Bill will be in the region of R256Billion, but
this figure will be revised as the Project is rolled out. Some analysts have
put the total cost in the region of around R450B, when taking into
consideration the current costs of National Healthcare as a percentage of GDP. Right
there is already a huge problem; when the Einsteins of a piece of legislation
don’t even know how much said legislation is going to cost…..
Funding for the Bill, will be borne out of a series of
Taxes; (and don’t take the phrase “born free, taxed to death”, lightly).
- General Tax,
- Medical Scheme tax credits,
- Employee and employer payroll taxes, and
- A surcharge on Personal Income Tax.
The Establishment of an NHI Fund,
which would be a centrally controlled State-owned entity, (you know, like the
many failed SOEs that we already have), will be introduced to manage and
control payments into and out of the scheme, to ensure “transparency” and “Accountability”……right!
The services offered by the NHI
have been touted to be basic comprehensive healthcare services; although, no
definition of these services have yet been documented in the Bill. The bill
states that a person seeking health care services from an approved health care
service provider must be registered as a user of the NHI fund, and must present
proof of such registration in order to use the benefits to which they are
entitled; likewise with specialist services. Over time your medical aid will
provide only health services that are not covered by the NHI. But, as
mentioned, these still need to be defined. Once you are a registered member of
the NHI fund, you cannot seek specialist services directly without consulting an
accredited NHI Service Provider, who will refer you to a specialist if the
required service is not covered by the Fund.
According to the Project
timeline, and rollout, it is expected that full implementation should be
completed by 2026, with a dramatic downscale in the number and size of Private
medical aid schemes. Given the murky details and failures during the Pilot
phase, the target date of 2026 is wishful thinking, as opined by analysts in
the Sector.
And that, in a nutshell is what
the National Health Insurance scheme is all about.
From A layman’s
Perspective
There is no doubt that our (Public)
Health system is in a bad state of disrepair. The fact that more than 80% of
the population is subjected to it, makes the task of regulation that much more
challenging. That less than 20% of the population enjoys quality superior
healthcare, one could say, is a travesty of justice. However, dismantling the
Private Healthcare system to accommodate the goals of this NHI scheme is
definitely not the way to go. And on the face of it, this is exactly the intention. The adverse repercussions that would result from such
careless legislation can only be destructive to the system as a whole. The Pilot Phase has highlighted crucial inconsistencies with many unworkable solutions. None of the highlighted issues have satisfactorily been resolved, but the first phases of the plan has already been launched in Provinces like KZN and the Eastern Cape.
Any
layman could see that the natural progression of achieving the goal of universal, quality
healthcare for all, is simply to fix what is broken, and then apply legislative
changes, in phases, to accomplish that goal; ensuring that all
stakeholders are accommodated fairly. There are numerous examples of Global countries with efficient world class Healthcare Systems that can be used to model a
system successfully. But contrary to a layman’s opinion, our esteemed leaders
in government don’t really see it that way. They prefer the bulldozer approach
to fixing shit.