A New Push for Public Health Care Reform

A Look at South Africa's Proposed National Health Insurance Scheme

Oct 7, 2009

As the world pays rapt attention to the health care debates in the United States of America, South Africa is on the precipice of monumental health care reform.

The financing of public health care is a highly emotive issue particularly when faced with serious systemic problems within the healthcare system. Although South Africa has one of the strongest economies in Africa, it is bogged down by much of the same issues with regards to public health care that plagues the rest of the continent. The state health care system is under-resourced and grossly understaffed. Added to this is the fact that the country has one of the highest HIV infection rates in the world.

The South African government, particularly the ruling African National Congress (ANC), has to consider the historical inequalities in health provision and the fact that the country's population is largely uninsured with many unable to afford insurance.

The Proposed New Health Insurance (NHI)

The newly installed Health Minister, Aaron Motsoaledi, announced the government's intention to ditch the current system of health care financing in his first budget vote speech in parliament. In its June 30 2009 article, 'Health care model 'unsustainable' ', the South Africa Press Association quotes the minister as saying that the "present system of health care financing can no longer be allowed to go on, because it is simply unsustainable". According to him, only 3.5 percent of GDP catered for 84 percent of the population.

The minister, and the ANC, has proposed a National Health Insurance scheme where every citizen is covered. In his first State of the Nation address President Jacob Zuma confirmed that the NHI is going to be a priority program for his administration. This would mean that, in the near future, funds administered by the government would pay for individual visits hospital or clinic. Each person would be allowed three visits a year to a participating general practitioner.

Is the NHI Feasible?

Few would argue that the poor need to be insurance but the contentious issue is how it would be paid for. Current proposals include the payment of additional taxes and insurance contributions by the middle and upper classes.

The public has gotten a peek at the efficiency of a government run medical insurance scheme in the form of the Government Employees Medical Scheme (GEMS). GEMS has been relatively successful but there have been a number of issues relating to administration. Before the NHI can be implemented, it is advisable that lessons be learnt from GEMS.

State hospitals need to be scaled-up to meet the inevitable increased demand and the rate of migrating medical personnel needs to be curbed. With a crumbling health system that is currently unable to cope with: the HIV pandemic; unacceptably high maternal and child mortality rates; as well as victims of violent crime, serious questions need to be asked about the feasibility of the NHI.

The best route before the NHI is implemented is to ensure that the systemic issues are dealt with. If these issues are not dealt with the NHI is doomed to failure.

The copyright of the article A New Push for Public Health Care Reform in South Africa is owned by Odilile Ayodele. Permission to republish A New Push for Public Health Care Reform in print or online must be granted by the author in writing.