Health is an essential component of being human; both the positive and negative connotations have deep resonance with the human psyche. When we are sick, hurt, dying, the consequences extend beyond the personal, affecting families, communities, the economy and the well-being of our nation.
Our ability to thrive as a country is intricately linked to our health. Having an educated and trained workforce is not sufficient: physical and mental well-being are necessary for productivity. The greatest natural resource a society has is its people, and its success depends on how they are nurtured and cared for.
Our healthcare system influences our ability to participate in the global economy. Which is why asking “can we afford NHI? [National Health Insurance]” is the wrong question. We should rather be asking whether we can afford not to reform our healthcare system. An accessible, affordable, quality healthcare system has to be a key step on our journey, not an unattainable dream.
Here’s the context: according to World Bank statistics, the richest 10% of South Africans have 47% of all income, while the poorest 10% have 0.2% of all income, one of the greatest levels of income disparity in the world.
The apartheid legacy is that half of South Africa’s expenditure on healthcare currently flows via the private sector. Only 16% of the population have medical scheme cover. This means that the remaining 84% of people depend on the public health system, or have to pay out of their own pockets for private care.
Indeed, income equals access to quality healthcare in today’s South African set-up. There is no doubt that many people are not having their needs met by the current healthcare system. Concerns about the current and future state of healthcare are frequent topics of dinner table conversations – from the high cost of prescription drugs to the lack of affordable health insurance and the difficulty in accessing quality healthcare in some rural areas.
Healthcare costs, whether they take the form of escalating medical scheme contributions, out of pocket expenses or the indirect costs of transport and missing work, have a severe impact on families. We all have experiences, whether personal or in our families or communities, which reflect the significant costs associated with poor access to care.
Stories of people postponing care until they are severely or dangerously ill, stories of misdiagnoses, of incomplete treatment, of the struggles to navigate a complex system. Even in less extreme cases, the costs of lost time at work and the effect of carrying illness to work and school are a drain on our entire community.
NHI is the most far-reaching series of health reforms since the abolition of segregated health services after 1994. NHI centres on the idea of a single pool of money to finance health services, but in reality is a complex set of inter-related reforms.
The government success will be measured against its ability to achieve the objectives of the NHI.
These objectives, in summary, are:
» Improving access to quality health service;
» The pooling of risks to achieve equity and social solidarity;
»The procurement of services on behalf of the entire population combined with the efficient mobilisation of financial resources;
»The strengthening of the under-resourced public sector;
» And improving overall health system performance.
Healthcare is one of the 12 main delivery outcome priorities identified by government’s National Development Plan. It is also considered to be a basic human right that is protected by the South African Constitution.
The NDP’s Vision 2030 envisions that the South African economy will achieve 120% growth in real per capita gross domestic product by 2030. The current economic outlook falls far short of that vision, bogged down by increasing unemployment, a volatile currency, a commodity slump and the risk of a credit-rating downgrade.
A recent study by the African Development Bank placed South Africa in Africa’s 10 slowest-growing economies and analysts predict it will soon be surpassed by oil-rich Nigeria as the economic powerhouse of the continent.
Some commentators see NHI as increasing the economic risks faced by the country, while others see it as an investment in human development which will enable us to achieve the NDP vision.
Either way, we agree on the challenges faced by the public healthcare sector in South Africa:
» Weaknesses in health systems management;
» Failures in the training of sufficient health professionals; poor accountability;
» And the skewed allocation of resources between the public and private sectors.
As South Africans, we need to understand that if we are to thrive in today’s world, we cannot waste any of our human capital – young, old, rich, poor, urban, rural.
We need to mobilise our entire population to contribute to the growth and development of our country. That calls for coherent and integrated transformation of our health system.
Large-scale reform of our healthcare system is not possible without strong leadership and deep political and social commitment.
For NHI this means figuring out our policy options, and the costs and benefits of those options. We have to find those changes that we can afford to make, and those that we cannot afford not to make.
Implementing the NHI reforms will require careful sequencing and planning to ensure that we make the best use of the resources that we have, and that we build something sustainable.
Employers are a key stakeholder in the changes that lie ahead. With everyone looking to save money and cut costs, poor employee health is a missed opportunity.
The economic benefits to having healthy employees mean that employers have to acknowledge the impact NHI might have on the bottom line.
If our people are to contribute and benefit from a productive economy, we must transform our health system in a way that sees health and other sectors as interconnected and critical for the well-being of our society.
There is indeed a nexus between a healthy nation, productivity and economic development. Key to economic development is the health of our country’s current and future workers.
A healthy society is a productive society.
»Shivani Ranchod, consulting actuary at Insight Actuaries and Consultants, a market leading actuarial and consulting services company operating across the health, insurance and employer sectors, will be an Afrocentric Health’s panellist at a breakaway session of The Vision 2030 Summit on June 8 at Emperors Palace