HEALTH Minister Dr. Aaron Motsoaledi has again mounted a spirited defence of the government’s National Health Insurance (NHI), stating that the system was not unique to South Africa and its rollout was imminent.

Motsoaledi was addressing hundreds of delegates to the SA Communist Party’s (SACP’s) four-day special national congress at the Birchwood Hotel in Ekurhuleni.

The minister warned that the issue of the NHI was going to embarrass the country in the long run if it is not adequately addressed.

Motsoaledi cited the example of the US, which he said spent 22% of its gross domestic product (GDP) on health and that this accounted for 43% of the global spending on health.

The World Health Organisation (WHO) set the target of 5% of the GDP for all countries while South Africa spends 8.5% on keeping the nation healthy.

“We should put financial considerations aside and treat everyone whether you are a billionaire or poor,” Motsoaledi suggested.

On the cards is the rolling out of eye and hearing tests to all grade R pupils starting school, which Motsoaledi said would be the NHI’s first project.

Grade R, the reception year before grade one, has been made compulsory by the government in terms of the Basic Education Laws Amendment Act.

Also being planned is granting pregnant women access to four doctor’s visits during their pregnancies.

Motsoaledi expressed confidence that the government would be able to cost both interventions but not the entire NHI, which he said was impossible and dismissed suggestions by healthcare provider Momentum that the plan could cost R1.3 trillion to provide all South Africans with the same quality of healthcare provided by the private sector.

He said he found it strange that access to healthcare was declared a fundamental human right that should be protected as far back as 1948 yet people must come and buy that right.

“That can’t be correct [and] it’s happening in South Africa,” Motsoaledi complained.

During his presentation, he described NHI as simply a healthcare financing system.

“When you receive that healthcare you must not suffer financially,” Motsoaledi added.

He explained that there were three mechanisms of healthcare financing – mandatory prepayment (the government’s health budget), voluntary prepayment (medical aid) and out-of-pocket, which refers to cash.

Motsoaledi said the NHI was mandatory prepayment and in South Africa 60% of healthcare is mandatory prepayment and cash (out-of-pocket).

He continued: “This is worrying on a continent where people generally do not have money you’re expected to pay cash”.

Motsoaledi also believes that a myth that must be demystified is that people need money to get universal healthcare.

“Your treatment should not depend on the amount of cash you have,” he told delegates.

In a chilling warning, Motsoaledi also cautioned that if South Africa does not change the existing healthcare system there would be instances such as the one in which a health insurance company UnitedHealthcare boss Brian Thompson was recently killed and people celebrate his death.

Thompson was shot dead in what is widely described as revealing the public frustration with the health insurance industry in the US.

Motsoaledi said while South Africa spent 8.5% of its GDP or R570 billion on health above the WHO’s recommended 5%, 51% goes to 14% of the population and the remaining 86% share 49%.

In addition, every year the current’s public office bearers including President Cyril Ramaphosa, government employees including those in state-owned entities are subsidised by R70bn to access private healthcare as well as R30bn in tax rebates/credits.

Motsoaledi asked: “Why are public representatives and public servants getting so much subsidy that the masses do not get?”

He said private healthcare, which makes super profits, calls the shots and can also call any price largely due to market concentration.

Motsoaledi said in the country only 10% of Africans are on medical aid compared to 72% of whites.

In 2010 the total medical scheme spend on health was just under R85bn and by 2022 it stood at R218.4bn.

The Universal Healthcare Access Coalition, which includes several national organisations representing a substantial proportion of the country’s healthcare professionals, said the NHI proposals it assessed are not feasible and potentially detrimental to healthcare access.

“The NHI plans lack alignment with the current healthcare system, neglect necessary reforms and fail to address governance and equity issues in public and private healthcare,” reads the coalition’s report released on Wednesday.

It added that for over two decades systemic weaknesses including governance failures, inadequate service delivery and inefficiencies in both public and private healthcare have remained unaddressed.

Motsoaledi decried the fact that Netcare’s Park Lane Hospital in Parktown, Johannesburg had 56 gynaecologists, which he said were more than Mpumalanga, Limpopo and the North West put together.

loyiso.sidimba@inl.co.za