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Opinion
/ 14 May 2024


NATIONAL HEALTH INSURANCE AND LESUFI’S HONEST APPRAISAL OF PUBLIC HEALTH
FAILURES

By Mike Settas
FacebookXEmailLinkedInWhatsApp
Despite what Panyaza Lesufi has said, once Cyril Ramaphosa puts pen to paper,
the games will commence, as a slew of lawsuits are in the pipeline ready to
outline the NHI’s many fatal flaws. File photo.

Gauteng Premier Panyaza Lesufi made some incredulous announcements this month
regarding the as yet un-birthed National Health Insurance (NHI).

In full-blown campaigning mode he claimed in support of NHI: “After 29 May, any
citizen can go to any hospital, private or public, to receive the best treatment
and that afterwards government will pick up the bill”.

Such shameless populism tells observers that panic is enveloping senior ANC
politicians, who are fearing that the electorate is no longer buying their false
promises.

Confessions from a politician

But Lesufi’s subsequent verbal contortions consequently became major confessions
on how bad public health services are.

His rhetoric subsequently escalated into the following pearls: “Gone are the
days that if you don’t have medical aid that you must die”, along with, “Gone
are the days that if you don’t have medical aid that you must be mistreated in
our hospitals”, and finally, “Gone are the days that if you don’t have medical
aid that you are even scared to go to hospital”.

In this regard Lesufi is being honest, confirming the horrors that citizens
experience when going to public hospitals. In particular, his word choice in the
confession that citizens are “mistreated in our hospitals” is extremely
revealing. I would have to assume that he inadvertently ended in a verbal
cul-de-sac with such an honest appraisal of how poorly the ANC has managed the
country’s public health services.

The NHI’s dishonesty

However, where he is being entirely dishonest is following the ANC party line on
NHI. The origin of his statements is founded in the false notion dreamt up
during the NHI policy process; that the reason public health facilities are in
such a mess is that the private sector “steals” all the healthcare resources in
the country. Hence Lesufi’s inferences that you are okay as long as you are
covered by a private medical aid.

Nonetheless, given this populist NHI policy position the ANC must therefore
destroy the private health sector, raise substantial new taxes, and take full
control of all health services, private and public. As far as populist and
socialist policies go it doesn’t get much worse than the NHI.

However, what this policy stance conveniently conceals is what resources have
been available to the government and how they have subsequently performed with
them. The picture is far from pretty.

Public sector resource boom

Contrary to the narrative of understaffing, from 2006 to 2019 the ratio of
public sector medical personnel per 10,000 population improved in all but three
out of 28 clinical disciplines. This was achieved on the back of public health
budget increases that far exceeded CPI and population growth each year from 2000
to 2020. Only in the last few years have budget increases come in lower – a
result of our burgeoning debt levels and budget deficits – but they still remain
above CPI.

For a country of our upper-middle income development, our current total public
health expenditure (4.1% of GDP) falls squarely in line with the average for all
upper-middle income countries (also 4.1% of GDP). If you add further tax-funded
health expenditures such as the Workmen Compensation and Road Accident Fund, and
also consider that the new infrastructure and maintenance budgets for public
healthcare facilities are allocated to the Department of Public Works, South
Africa’s total public health expenditure is closer to 5% of GDP.

In monetary terms, our per capita public health expenditure ranks 17th highest
out of 51 upper-middle income countries, whereas our clinical outcomes rank
amongst the worst of this peer group.

Our clinical outcomes have deteriorated to such an extent that nationally
medical malpractice claims against the state exceed R80bn as of March 2023.

It is very telling to note that the medical malpractice claims of the Western
Cape, managed by the DA provincial government, are nil. Their maternal and
infant mortality rates are also substantially lower than every other province.
These outcomes are not due to better resources, since the provinces operate on
equal per capita budgets, where the national health budget is distributed
proportionally using the provincial equitable share.

The Western Cape achieves substantially better outcomes based on the same per
capita budget and with the same institutional design as all the other provinces.
It amply proves that better health outcomes can be achieved within existing
healthcare resources.

The NHI and elections

Nonetheless, given Lesufi’s leveraging of the NHI during his election
campaigning, one must conclude that President Ramaphosa’s promise to sign the
NHI into law before the elections is one of a few that he will keep, as was
announced on Monday night.

Preceding this point, the passage of the NHI Bill through the National Assembly
and the National Council of Provinces (NCOP) was a complete farce, as any
objections against NHI or even interrogations underpinning its reasoning were
rejected outright by the ANC dominated health portfolio committees.

Even advice from the Parliamentary Legal Advisor that the NHI Bill is not
constitutional was ignored. The ANC needs the NHI for these elections more than
it ever has, and it is no coincidence that the NHI Bill was rammed through both
houses of parliament last year.

When Ramaphosa puts pen to paper on Wednesday, the games will commence, as a
slew of lawsuits are in the pipeline ready to outline the NHI’s many fatal
flaws.

Mike Settas chairs the Health Policy Unit at the Free Market Foundation.

Tags: ANC politics, Gauteng premier, Healthcare budget, healthcare system,
Medical Aid, National Health Insurance, NHI bill, opinion, Panyaza Lesufi,
Public health services, South African Politics


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