Among the alternatives put forward is a tax-funded voucher system. [Picture: via HBS]
The appalling conditions at the state-run Helen Joseph Hospital may have caused a stir when broadcaster Thomas Holmes recorded a rant. Yet little heed has been paid to his parting shot, a warning about the government’s National Health Insurance (NHI) policy.
Health minister Dr Aaron Motsoaledi this week doubled down on critics of the NHI, a centralised insurance fund. In the latest thrashing, he accused private stakeholders of “mathematical hooliganism”. This after Momentum Health Insurance estimated it would cost around R1.3 trillion per year.
The controversial law was signed into effect just before the 2024 elections, although many aspects of its implementation remain unclear. For example, the services that will be covered by the NHI remain a mystery.
Asked whether fears around the negative effects its implementation will potentially inflict on the healthcare system, Dr Angelique Coetzee of the Solidarity Doctors’ Network (SDN) said:
“We cannot say the NHI will worsen the conditions [but] you cannot think that an NHI will actually improve your conditions of the public sector hospitals.”
What the NHI will not achieve, she warned, is quality healthcare for all. “Unfortunately, there are some expectations that once NHI has been introduced, that miraculously you will now be able to have better infrastructure at the buildings [and] better access. It’s not really going to happen.”
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Healthcare vouchers
The Institute of Race Relations (IRR) has done extensive research on the NHI. While opposing the policy, it has developed an alternative: a tax-funded vouvher system. Hermann Pretorius, head of strategic communications, outlined how this would work.
“Instead of the government taking the responsibility for massive healthcare spending and resource management, the bulk of state spending on healthcare is packaged into means-tested vouchers that go to individuals allowing them to spend those vouchers at the medical practices or hospitals they choose.
“Currently, poor South Africans are essentially given no choice as to the healthcare they receive. Vouchers will change this, allowing the state to shoulder its responsibility in looking after people by providing the necessary funding, but giving people the choice of where they want to receive care from,” he explained.
Those who can afford medical aid – roughly 10 million, or 16% of the population – are able to access world-class healthcare services at private facilities. Facilities are clean, services are efficient and reliable.
However, the remainder, comprising the vast majority, are forced to turn to a public healthcare sector that is plagued by corruption, inefficiency, and is under-resourced. This makes seeking treatment at a public facility a hazardous affair.
Both the NHI and the IRR’s voucher system are aimed at improving access to healthcare. So how does the latter differ?
Said Pretorius: “Vouchers put the spending choice in the hands of people, where the NHI centralises all healthcare spending under the government’s power. NHI will minimise the choice there currently is in the South African healthcare system, leading to a less competitive environment and therefore limited incentives to offer quality care”.
“Not a bad suggestion,” Coetzee commented. However, she added, “one needs to sit with it and look at the feasibility of this.” The search for alternatives, she said, was ongoing.
“There is a lot of work going on in the background, where we all try to come up with better solutions, but the big one is actually how to get better access without overburdening the public sector and simultaneously trying to get public sector infrastructure, HR problems, corruption … how can we mitigate that and try to fix that.”
The IRR’S own polling shows a whopping 86% of South Africans would be in favour of a voucher based system for healthcare. Likewise for housing and education. If implemented, said Pretorius, the freedom to choose could go some way in restoring the dignity of patients.
“If the harrowing video shows anything, it is that healthcare for the poorest and most vulnerable people in our country urgently needs to be refocused on dignity. And vouchers allows for the foundation to be put in place,” he said.
