A health check on South Africa shows a country deep in recovery.
As South Africa continues on the road towards adopting National Health Insurance experts have warned that a sluggish economy, centralised state entities and an under performing health care system will make that task all that harder.
Speaking at the Hospital Association of South Africa conference 2023, that was held in Cape Town, Dr Paula Armstrong of FTI consulting told the audience that the effects of the Covid 19 pandemic still held sway over the economy.
“The economic growth rate is not looking good,” she said. “South Africa’s growth is still constrained and is likely to remain that way.” She painted a picture of high unemployment, dwindling salaries, rising inflation and the economic effects of loadshedding.It is in this environment that she outlined what the costs of NHI would be if the government used a single payment system.
According to figures that were compiled in 2011, the South African government would have to raise 200 million rand through taxation. “This would require raising VAT from 15%, to 21.5%. And a 31% increase in personal income tax across the board,” Armstrong said.
However, to find a model to fund the NHI, Armstrong believes a priority is to identify who the medically uninsured are and try and get them in the system. They make up 84% of the population, are either on social grants or earn less than R70000 a year.
“These are the people who should be prioritised in any kind of NHI, or public sector provision,”Armstrong said. There are also another 14,5 million South Africans who are slightly economically better off who could be provided medical insurance through perhaps risk pooling or the use of a low cost benefit, she added.
Professor Alex van den Heever of Wits University during his presentation warned that if the NHI operated as a typical centralised government entity it would likely fail as so many SOES have done in the past. This concentration of power can often remove the checks and balances that open them up to corruption.
“What we have is a governance problem. It is all about the accumulation of power and the only way to stop it is to not allow it,” he said. “Now, if you allow your regulators to be captured, if you create legislative frameworks that aren’t enforced, then you’re allowing this accumulation of power to occur.” Van den Heever said that you needed people who respond to communities they serve rather than political parties. A decentralised entity is more innovative, he said.
Economist Professor Ronelle Burger of the University of Stellenbosch added to the conversation by giving the South African Health Care system a medical check up. Her research, she told the audience, has shown a healthcare system that is not doing the basics right and is under performing when compared to developing countries in the same category as South Africa. For a start it is an unequal, polarised health care system. In this system the private care sector accounts for employing two thirds of the doctors and half the nurses, while catering for the needs of one out of five South Africans. The poorest, Burger said, are likely to suffer the effects of stock outs, in particular TB drugs. “And these stock outs are more likely to lead to deaths,” she said.
There is also a disease divide in South Africa. “What we know is that deaths from certain diseases are almost unknown amongst the affluent, while diseases like TB, HIV and diarrhoea are quiet prevalent with the poor,” she said. Research also found that health professionals in some hospitals were not collecting enough information from patients.
Burger said that collecting up to date data is important so as to understand the challenges facing the South African health care industry and plotting the way forward for the adoption of the NHI. Health Insurance, her research, found had a positive effect on those using it. People were more inclined to use it, because of the convenience. Those on health insurance go to the doctor more often, than those who aren’t.
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