Letter | Insufficient capacity for NHI to function
Government releases bill that will change SA healthcare system
The 64-page main body of the National Health Insurance (NHI) Bill raised more questions than it answered.
Chief among them was to wonder if, given the government’s handling of its responsibilities thus far, Health Minister Aaron Motsoaledi hadn’t somehow lost touch with reality.
The fact is that regardless of how nice the bill’s preamble sounds, adequate healthcare coverage for the entire country is impossible for at least three reasons – more really, but there’s no space.
First, the cost component – time, system development and implementation (bureaucracy and infrastructure), education and training of all medical staff, medicine and equipment development and deployment.
All of these, and more besides, at the end of the day, come down to money neither the government nor the private sector has at the best of times on the scale required, never mind when the economy performs poorly like ours has for the last seven years or so.
Second, the NHI would depend on 100% accurate data inputs, starting with “user” (whatever happened to “patient”?) names and ID numbers.
Considering that comes from Home Affairs, a department known for massive corruption and incompetence, what would happen if you were wrongly declared dead last week and today need an ECG, or worse, your parents never bothered to register the birth to begin with?Third, there’s the matter of service capacity.
According to data from 2016, there are 25 government and 92 private sector general practitioners (GPs) per 100 000 people.
That translates to one GP per 854.7 people for a population of 56 million.
Well, the rigid “referral path” of the envisaged system starts with registering with a GP, then seeing that GP before going to a clinic and then hospital.
The administrative burdens on GPs due to the 1:854.7 ratio will be unbearable.
The service they can provide in such circumstances will be at best minimal, but more likely non-existent, especially if more than 16 patients need to see the doctor in one day.
Now just imagine if your GP died. Worse, by virtue of being forced to skip this step due to a possible 53-day wait to see the doctor, “users” will end up being liable for subsequent healthcare costs because they deviated from the “referral path” – yes, that’s in the NHI Bill.
The issues of cost and funding are addressed only in the vaguest terms, while the bare bones requirements for participating healthcare vendors are met at 80% by only eight of the hundreds of state facilities.
According to columnist Max du Preez, the yearly running cost of the NHI is believed by the Davis tax commission to be R256-billion.
The cost of merely setting up the system is believed by another columnist to be R500billion at least, a burden which the budget clearly can’t support.
In truth, nobody knows how much the NHI will cost, but what is clear is that it won’t work without the private sector.
The problem is that, unlike the government, the private sector can’t mess around or issue taxpayer-backed bonds to cover shortfalls.
Therefore, if the private sector joins the NHI as healthcare providers, it runs the serious risk of losses, cash reserve depletion and bankruptcy if its bills are not paid promptly – and when has the government ever paid private contractors on time or in full?
As such, chances are private sector vendors won’t join, or will do so only in the least risky way possible.
Given the current state of the government health sector, that would render the NHI an immediate failure.
Even if it does not, two things will happen anyway: the system will become rigid and unable to cope with demand spikes, as well as so complex that the smallest error will kill hundreds, if not thousands of people.
I say this because last December, the British National Health Service (NHS) was swamped by “users” suffering from respiratory problems.
GPs couldn’t cope with the workload, hospitals were filled past capacity and in the end they had to resort to triage, which got thousands of sick people kicked out of hospital beds.
Last month, it was revealed that due to a computer error, the NHS did not send invitations to more than 300 000 women over the age of 70 to get mammograms, of whom at least 270 are believed to have died because their cancer was spotted too late. That happened in the UK. What do you think will happen in South Africa?
Ultimately, my opinion is the NHI Bill is a disaster waiting to happen and we should avoid it.
If not, then I’m going to buy shares in funeral parlours because business will most likely boom.
-Mircea Negres, Port Elizabeth
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