Since the signing of the bill and the declaration by government to go ahead with the NHI plans, many have been gripped with fear and consequently have been spreading it to others like wild fire. There seems to be a general negative connotation within the South African environment at the moment with regards to universal health coverage.
A few myths have crept up which we can quickly put to rest:
-Will the 20% fund the 80% ?
-How can a system which is already struggling stretch any further?
-Will the funds be squandered or the entity managed like Eskom and others?
To begin, let's establish a few truths!
-No health care fund/ system or reform ever began once the nation was "ready" or in an overall "better/good state". The UK for example implemented their NHS after the war when the country was poor and struggling.
- Neither the current public nor private sectors are doing well. A system change is inevitably needed and a new funding model is a great tool for that change to begin.
- Already 8% of the current GDP is spent on health, how much more can they inject into health, being at the upper threshold already? An efficient system is encouraged.
- Most of those who spread fear and negativity have not actually taken the time to read the bill nor have they made contributions to the open documents that exist for commenting:
(https://dearsouthafrica.co.za/national-health-insurance-bill-2019/)
The NHI is a fund; which will be managed as a schedule 3A public entity and therefore a lot more strictly regulated as opposed to Eskom and the likes which are schedule 2 entities. This means centralize admin, specific committees, monthly rationing etc This fund will also not solely come from tax payer increases as some imagine but mostly from a pool of tax shifts, payroll tax, medical schemes, and surcharges on PIT among others. The "20% cannot and will not fund the 80%"! Everyone is contributing proportionately. 29% of unemployed youth do not represent 80% of the population and payroll tax is only one source of funding as mentioned above.
Additionally, with the concerns around implementation, phases are being rolled out until the official 2026 full implementation. Therefore, the "readiness" will inadvertently be ironed out progressively through each phase. For example medical aids will continue as usual until legislation (about 12 of them in total) changes and their new scopes are redefined.
The issue of staff shortage, is also going to improved. Currently, for every medical practitioner in the public there are five in the private sector; they are concentrated in certain urban areas. By allowing public and private to mix, this ratio can shift resulting in a wider population reached and serviced. A similar story can be told about facilities where the majority of public facilities are flooded with patients while in private, many institutions have for instance 30% occupancy thus waste resources, charge more to make up for them and hence treat populations inefficiently. Sharing workforce and infrastructure to all patients will improve efficiency. Of course a point to upgrade and train adequately should be made and is included in the model for sustaining health care services.
Many have also raised the question on pilots failing? First of all pilots don't fail! They are a testing tool to assess a new avenue. Therefore the "failed" reports can only serve to improve each phase design and implementation onward. Also, the NHI in itself could not have been "piloted" as the fund setup and other details around it require legislation changes first. Rather, the pilot sites used for testing have had mixed reviews due to poorly documented techniques and results, thus revealing poor research strategies (copy and pasted plans did not get necessary tailoring per district) as opposed to poor concepts. To understand the value of the roll outs (pilot sites), just ask the primary beneficiaries: the patients who previously had to queue the night before or the full day of collection to receive their chronic medication; who have already began to receive their chronic medication parcels in many external pick up points of rolled out districts and they are overflowing with gratitude at their new found efficient access to health care.
One more thing to consider is the majority. let's put ourselves in the shoes of the poorest; those who have no option, and no alternative. As the privileged bunch, let's not think that attempting to provide for others, is an oppressive attack on ourselves. The search for equity is primordial.
The more we empower people to contribute, the more we also enable them to consume and have options. The right to access quality efficient health care should immediately be followed by the responsibility to contribute towards it. The new health care system will thrive as more patients escape the poor / unemployed / uneducated pool, take on employment and healthy lifestyles which decrease disease burden overall. Patient education is key.
No system is perfect. Any alternative model (suggestions rather than complaints are welcomed) would also have flaws. However this is the option that was chosen and government should now run concurrent models (for example the voucher model) in various districts to establish which model variants work best, confirming their choice.
It's also important to note that universal health care is not a SA concept. The rest of the world has already fought for decades to try and reach it. The WHO is mandating for the rest to follow suit in their vision 203p for the whole world.
Affordable care and quality care seem to be at opposites of the spectrum. How can they both exist unless some win and some lose? How does equality and equity factor in together? Until we stop viewing the fund as an all or nothing ideal, we will miss the many nuances in between. Being for the NHI doesn't have to be at the expense of precautionary scrutiny and acknowledging evident complexities.
SA should definitely NOT panic, rather shake the fear, toss the negativity and get involved in the deep understanding of the great need, the many benefits, and mitigating the flaws, while actively participating in the shaping of the NHI and the ideal health care system which is envisage for all.
#NHI
#Equity
#transparency
#joinTheConvo
#HEALTHCARE
#universalhealth
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