National Health Insurance – Threat or Opportunity for Family Doctors?

Abstract

The debate has begun. A national Health Insurance (NHI) system for South Africa is finally on the cards. It was contemplated by the Smuts government in 1941 but disbanded because of political apposition and funding limitations. The ANC government has finally committed itself to its 1994 electoral promise. This time around there is little political opposition, but will there be enough money and knowhow? Few compatriots will disagree with the statement that our health system is “sick”. South Africa is spending 8.5% of its GDP on healthcare, ranking no 32 in the world, and yet in terms of the WHO’s rating measuring health outcomes, we are only no 175. This means we are spending a lot of money, probably all we can afford, but are not getting good results due to inefficiency. There is also a huge discrepancy between health care in the public sector and the private sector. The state will, in 2009/10 spend on average about R2 000 per year on each patient that it sees, and this will increase with the OSD salary increases. The medical schemes on the other hand will spend about R9500 per year on each patient that is seen through their system. It is a well known fact that the public health service is struggling, overburdened and not providing adequate health care to those dependent on it. The main reason is a lack of staff, particularly nurses and doctors. On the other hand the private sector is providing “world class” services, but fast becoming unaffordable for members of medical schemes. It is estimated that the cost of private medical care is gulping 30% of salaries in the formal sector. Clearly something has got to give in both systems and nobody can argue for the retention of the status quo. But what will the new system look like? The principle is that you pay according to your means and receive healthcare according to your needs.