The disemboweling of private healthcare

William Saunderson-Meyer says the NHI will be disastrous for all but the uber-elite


A shot in the arm for African health tourism?

It is becoming a hot topic in South Africa. Those on the left of the political spectrum think it is a disgusting betrayal of the collective. Those on the right see it as the simple exercising of individual rights.

It’s  the issue of ‘health tourism’ – the practice of avoiding inadequate local healthcare and instead jetting to foreign climes for sophisticated world-class medical treatment. Simply put, it’s the avoidance of filth, incompetence and interminable waiting lists characteristic of the “free” care at your public hospital, in favour of paying out of your own pocket for immediate, top-rate treatment.

Health Minister Dr Aaron Motsoaledi believes health tourism to be a reprehensible practice. The BBC reported this week that at a recent conference he was forthright in his criticisms, which were met with a stony silence from those present. 

That’s not entirely surprising, since he was speaking to an assembly of African health ministers. And the conference was being held in Zimbabwe, a country whose decrepit president spends more time in Singapore and Malaysia, being medically fine-tuned, than he does at home.  

“We are the only continent that has its leaders seeking medical services outside the continent, outside our territory. We must be ashamed of that… We must promote our own,” Motsoaledi said.

Motsoaledi is correct. But not for the reasons that he assumes. 

It is patently disgusting that many African leaders plunder their treasuries, causing their nations to fall into rack and ruin. It is also hypocrisy of the highest order for these leaders to seek abroad the medical care that, through their actions, they effectively deny to their own citizens. 

But not every African leader is a thieving rogue who should deservedly suffer if the health system at home can’t provide the most modern care by the best-trained doctors and nurses. There are honest leaders who are trying their best.

For example, there is President Ian Khama of neighbouring Botswana. And there is… Um...

Anyway, you catch my drift. Medical care is literally a life or death matter. There is no logical reason why the president of Nigeria, if desperately ill, as recently happened, should not avail himself of better care in London, than he can get in Lagos. Or nip down to Johannesburg.

For SA has a private healthcare sector that is world-class. We are a destination for health tourism.

So, the ethics of health tourism, of which Motsoaledi is so confident, are not an issue in SA, at present. That is soon going to change. 

The imminent implementation of the controversial National Health Insurance (NHI) scheme, if it takes the format that the hard-left element of the African National Congress wants, will disembowel SA’s private healthcare system.

At the root of the NHI approach is a deep antipathy towards the private sector. It is accompanied by a naïve faith, contrary to all the evidence of what is happening on the ground in SA, that state institutions can deliver services of similar quality as those of the private sector, more equitably and as competently.

In the NHI plan there is little attempt to integrate private healthcare, in the form of hospitals and physicians in private practice, into a partnership arrangement. Instead, the intention is that long term upliftment of the poor will justifiably come at the immediate, but temporary, disadvantaging of the comparatively rich. 

As private healthcare withers, the NHI supposedly will blossom. The middle and upper classes will be seamlessly absorbed into what will be a well-funded, well-run state sector, where they will, aside from their taxes, also be paying fees. 

A first step is to prevent private healthcare from being an option, but ending the tax credit that members of medical schemes get at present for their very expensive monthly subscriptions. According to an analysis released last week by Econex, the NHI plan to ditch such credits will force a fifth of medical scheme members, nearly 2m people, into the state health system.

It makes for the worst of all possible words. An overburdened public health sector will be brought to breaking point. The emigration of medical professionals will accelerate. It will be a vortex of pain and suffering.

Not for Africa’s political and business elite, of course. Those who used to come SA for treatment will simply go elsewhere in the world.

A new lot will join them. It’s the same lot who used to fulminate against SA’s private schools but now unhesitatingly send their kids to these halls of privilege.

It’s Motsoaledi’s political comrades who’ll be the new African health tourists. Should the good doctor need a quadruple bypass in 10 years’ time, God forbid, it’ll be interesting to see where the operation will take place. 

Any bets that it won’t be at Bara?

Follow WSM on Twitter @TheJaundicedEye