Living in a sick society
Throughout the world, there is an ongoing debate on it. While, the Europeans have made a great success of it and some say that their model should be applied to the entire world, American Conspiracy Theorists think that Former US President John F. Kennedy was probably killed for it. In 2008, Hillary Rodham Clinton lost the Democratic presidential nomination because of it. US President Obama mandated that everyone have it or companies have to pay a fine. Republican opponents scorned the law as ‘Obamacare’ and fought it with some success. Theoretically, National Health Insurance (NHI), should provide a respectable level of care to a large number of people, however it does come with a price.
The private price of healthcare
Healthcare is expensive. Medical costs have risen far above the inflation rate even though medication, through the production of generics, gets cheaper over time. It is a myth that the private health system is only accessed by the rich and middle class. Due to the alarming state of the public health sector, many poorer people get private health care through union membership, bargaining councils and smaller organisations. However, many smaller employers no longer offer their employees medical aid subsidies due to rising costs.
Providing employees with medical benefits and controlling the costs of such, is difficult in the private sector. Public sector establishments face additional obstacles from increased public scrutiny of government spending and the need to reduce costs while continuing to offer a strong benefits package.
Government, as an employer, reversed its decision in 2002 about open schemes and established a new restricted membership scheme, the Government Employees Medical Scheme (GEMS). GEMS was registered in January 2005 and became operational in January 2006. GEMS had grown to be the second largest scheme by the end of 2009. Public sector employees receive medical scheme subsidies from Government. In addition, there are a large number of public sector workers in semi-government enterprises on open medical schemes.
Medical aid schemes claim to provide protection and care without having to worry about the cost involved. Healthcare is a particularly intricate industry, making it difficult to comprehend plans and private health insurance costs and benefits. Should a serious injury occur, it could still lead to financial ruin. In a bid to sustain their financial viability, many medical aid schemes resort to increasing premiums, but decreasing members benefits.
In South Africa, the Council for Medical Schemes’ (CMS) job is to supervise private health medical schemes. The CMS implemented Prescribed Minimum Benefits (PMB’s), which is a set of defined benefits that allows all medical scheme members have access to certain minimum health services.
The issue of PMB’s and co-payments has resulted in court cases between the Association of Medical Schemes and the CMS. The system of PMB’s has failed to balance the health of an individual as a right and the sustainability of medical schemes. Out of pocket payments, co-payments, or direct payment to private providers, particularly even for those who are covered by medical aid schemes, confirms that the system is flawed.
The costs of public healthcare
The biggest problem with the proposed NHI, is dealing with the costs, which are usually funded through higher taxes. A government-controlled NHI Fund will receive funds from sources such as general taxes, a mandatory payroll levy, medical scheme contributions from GEMS and other public-sector medical schemes. This fund will be used to purchase services on behalf of the entire population from the public and private sectors.
Advocates of the NHI argue that everyone should have the right to be insured, and that current health care system generally only favours the wealthy. Opponents say that being forced to pay towards the NHI is a violation of their constitutional rights and that it is unfair to ask the wealthy and the middle class to subsidise the “welfare babies”.
Initially, the mandatory payroll levy from employers and employees could be lower than their current medical scheme contribution. But by using countries who have already implemented the NHI system as a guide, the levy will gradually increase to the level of contributions currently paid by medical scheme members. Employers will be forced to contribute the current medical aid subsidy they pay towards the healthcare of their employees to the NHI fund instead.
The health department argues that the implementation of the NHI will ensure the country will have a healthier and more productive workforce in the long term.
Expected quality
The NHI is due to be phased in over a 14-year period due to allow for the growth of health professionals and facilities. Members will have serve restrictions placed on them in terms of access to health care providers. Treatment at out-patient and in-patient facilities at public and private health facilities will be capped. Visits to any specialist or private hospital without authorised referral, will not be paid for.
Where to from here?
In April this year, Health Minister Aaron Motsoaledi, addressed MPs in parliament about the implementation of the NHI scheme. Motsoaledi said his department was about 90% of the way through audits being conducted by teams in hospitals and clinics, scrutinising things such as cleanliness, safety and security, drug stock count, long queues, infection control and the attitude of staff. The audits that are being carried out in KwaZulu-Natal, Gauteng, Free State and the Northern Cape will prepare for the rollout of the NHI in places where it will reach the poor.
A total of one billion rand has been granted by Finance Minister Pravin Gordhan, for the Department of Health to carry out NHI pilot programs. Motsoaledi said that the most difficult of the challenges his department faced was that of improving the health care system in South Africa.
The debate is not as simple as public versus private health care. For the NHI to be successful, partnerships between the private sector and public sector must be looked at. Both Gems and Parmed, the richly-funded medical scheme for parliamentarians, have incredibly large subsidies from government with good benefits. It is unlikely that public sector employees would be willing to give up their private health care benefits and submit fully to the NHI.
NHI should not be seen as a magic bullet to the problem of service delivery in the public health system.
