A glimpse of the NHI future – IRR

21 February 2022

In his 2022 State of the Nation address, President Ramaphosa reiterated his government’s commitment to the proposed National Health Insurance; he stated that “much progress is being made in preparing for the introduction of NHI.”

That the ANC government is still committed to the NHI should be fully expected – such a system of state-management of all healthcare is consistent with the prescripts of the National Democratic Revolution. A number of recent events serve to illustrate what healthcare in an NHI world will look like.

Many Gauteng doctors who worked over the 80-hour overtime limit were not paid their salaries for January;

Specialists and nurses are quitting South Africa’s public healthcare system;

Professor Adam Mahomed, Head of Internal Medicine at Charlotte Maxeke Johannesburg Academic Hospital, stated nothing has been done to repair the facility, nine months after a devastating fire;

Members of Parliament were shocked when presented with a report on the decrepit state of 1 Military Hospital – A failed repair and maintenance project accrued more than R156 million in irregular expenditure.

According to the IRR’s analysis of the NHI Bill, there is nothing in the proposed structure of the NHI that would solve the endemic structural problems in the public sector, as typified by the above examples. The National Planning Commission, a government body, said in its submission on the Bill that limiting the role of the private sector risks potentially destroying both private and public sectors simultaneously. Why has government as a whole not come to this realisation?

“Far from increasing access to quality healthcare for all citizens, monopolising the management of all healthcare services and workers in the hands of state will only bring all facilities in the private and public sectors to the same low level,” said Chris Hattingh, IRR Deputy Head of Campaigns.

The NHI will simply continue the trend of overbearing state interference and control over the economy that has wrought so much economic destruction over the last ten years. That President Ramaphosa reinforced the position that government will implement NHI served to undermine any notional overtures that he made towards the vital importance of the private sector.

Hattingh added: “If South Africans were shocked to learn of the corruption undertaken during the period of State Capture, they will likely not survive what is guaranteed to happen under an NHI. Instead of concentrating that amount of resources and political power in a single vehicle – thereby incentivising various forms of small and large corruption and cronyism – government should rather look at removing those regulations that inhibit the training of doctors and nurses, that disincentivise the building of new hospitals, and that discourage investment in medical equipment and technological advancements.”

It is likely that, if it is implemented, the NHI will see the largest exodus yet of healthcare professionals. Placing responsibility and control of all healthcare in the country in the hands of the state will lower service delivery quality, drive professionals overseas, and force the majority of citizens into relying on low-quality options, while more well-off citizens can afford to head overseas for their medical needs.

Issued by Chris Hattingh, IRR Deputy Head of Campaigns, 21 February 2022