NHI a corruption-filled gravy train waiting to depart - FMF

Foundation says it represents unachievable, unaffordable, and unconstitutional policy

NHI is a corruption-filled gravy train waiting to depart, FMF tells Gauteng Legislature

19 October 2023

The Free Market Foundation (FMF) Health Policy Unit this week submitted its comment on the National Health Insurance (NHI) Bill to the Gauteng Provincial Legislature (GPL), expressing its severe objections to the misguided scheme.

The GPL Health and Wellness Portfolio Committee is currently reviewing the Bill and considering the views of Gauteng inhabitants.

The NHI Bill is based on the failed socialist and centrist ideologies that fully underpin the current government’s model of governance. It will only enable political interference, cadre-deployment, and state capture in healthcare.

‘Government’s claim that the NHI is essential to achieve universal health coverage is misleading. It is an attempt to detract from its governance and management failure in the public health system,’ says Michael Settas, Chair of the FMF Health Policy Unit.

South Africa’s existing health delivery mechanisms in both the private and public sectors already provide a universal health coverage framework, as confirmed by the International Labour Organisation, the World Health Organisation, and the Health Market Inquiry.

The problem is not a lack of universal health coverage, but the poor quality of care in the public health system and the high cost of private care.

The NHI is the Department of Health’s attempt to deflect attention from these real problems.

Additional complaints by the department of ‘resource constraints’ in the public sector or ‘super profits’ in the private sector, also do not stand up to scrutiny.

‘Per capita public health expenditure has increased beyond inflation levels and population growth over the past two decades, so much so that per capita public health budgets now are double what they used to be. This has also meant that the ratio of public medical personnel to population has improved in 25 out of 28 different medical disciplines,’ says Settas.

‘However, from a health outcome perspective, matters have only deteriorated over this period, so realistically one then has to ask the tough question: why are we not seeing improvements in outcomes with all these substantially increased resources?’ adds Settas.

Widespread governance failings in the public sector, which have repeatedly been verified in audits from the Office of Health Standards Compliance, the Auditor General and the Health Ombud, lie at the root of these poor outcomes.

Not only does the NHI Bill fail to address these obvious governance problems, but it will significantly exacerbate them. The NHI Bill’s weak governance model will enable the political interference required to fill the NHI board and its numerous subcommittees with politically aligned cadres, to manage a NHI budget in excess of R500 billion annually. This stands in stark contrast with Chief Justice Raymond Zondo’s warnings that this prevailing manner in which the leadership of state-owned entities is appointed is unconstitutional and largely responsible for the enablement of state capture and failing public services.

Martin van Staden, FMF Head of Policy, adds: ‘Besides our deep concerns around governance, the NHI Bill also infringes upon several rights embodied in the Constitution. The NHI Bill prevents medical schemes from covering services covered by the NHI, which will deny everyone the right to receive healthcare from service providers of their choice. This imposition effectively nationalises the private healthcare sector, forcing doctors to become servants of the state or, in the more likely event, emigrate.’

Issued by Anneke Burns, FMF Publicist, 19 October 2023