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14 Feb 2014 00:00
Critics say the NHI will be unsustainable, but that there are other ways to extend quality healthcare. (AFP)
It is unfortunate that, instead of answering the questions posed in my comment piece "Let's talk about this revolution", Health Minister Aaron Motsoaledi has chosen to play the man and not the ball.
Serious questions have remained unanswered since the publication of the National Health Insurance green paper of August 12 2011 concerning the future of the private sector and the benefit package that consumers can expect under NHI, questions that the minister has ignored in his reply, "Physician, don't fool yourself".
The minister is correct in drawing our attention to the small size of the South African economy in relation to Britain or the United States but this serves only as a warning that consumers should not expect a comprehensive package of benefits comparable with those available in Britain's National Health Service, for example. That being so, is it not time for the minister to tell South Africans what they can expect under NHI?
South Africa is a country with a massive wealth disparity and formidable unemployment and poverty challenges.
Officially there are 14.4-million registered personal taxpayers in a population of 55-million but, according to a study by Dawie Roodt and Grant Thornton, a mere 5.7-million of them carry 97% of the personal income tax burden.
Writing in Business Day in 2009, economics professor Servaas van der Berg and healthcare actuary Heather McLeod warned: "Our fear is that the proposed NHI will fail to meet the expectations of the poor, will leave medical scheme members worse off, will be massively expensive or even completely fiscally unaffordable, and will require more doctors and nurses than are available.
Van der Berg and McLeod estimated that the government would require R251-billion for a basic benefit package and R334-billion for a comprehensive package.
Also writing in Business Day, Annabel Bishop of Investec noted that costs in the NHI working paper had not included the effects of inflation and that salary and wage increases would push the healthcare budget to R860-billion by 2025.
These comments appear as prescient today as they were when the articles first appeared in 2009. Given the massive fiscal challenges facing South Africa – all deservedly claiming their share of the budget – it is difficult to understand the state's determination to push ahead with such an expensive and untested option as NHI. The parlous state of our water supplies means that the health needs of our citizens could be better served by ensuring safe drinking water (said to cost an estimated R700-billion, according to a department of water affairs spokesperson interviewed on Carte Blanche).
The private sector supports many cost-effective proposals on how to make the sector more affordable to more South Africans, proposals that will assist the minister in fulfilling his constitutional obligation to improve healthcare progressively within the limits of affordability.
Our request for a constructive dialogue therefore stands.
Dr Chris Archer is the chief executive of the South African Private Practitioners' Forum.
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