National Health Insurance

Andrew Layman:  PCB CEO

In a recent debate about the National Health Insurance scheme that government wishes (is committed?) to introduce, an antagonist suggested that the scheme would not be successful unless it followed a complete overhaul of the public health sector.   As long as this was so poor, and so wasteful of resources, national health insurance would simply augment the waste of money.   The protagonists, however, hold a scheme of this nature up as the means whereby the public health system would be revitalised.   Government appears to be quite paralysed between these to polar positions, such is its apparent prevarication.    The frustration of medical aids and other players within the sector relates as much, if not more, to the lack of direction about the scheme rather than the underlying principle of it.   In such a climate of uncertainty, stakeholders begin to imagine their own scenarios and these are often quite negative.  This results in a groundswell of negativity even before the plans and blueprints are clear.

Some years ago, government put out a policy document that explained where it wished to go as far as national health is concerned.  Whether this document has been taken into account by the ruling party as it is now, I cannot say.   The idea of a NHI scheme seems to have emanated from the ANC’s Polokwane conference, even though there were plans in this regard before that.   At the time, I thought that the plan made a good deal of sense.   In essence, it proposed the funding of medical aids from a central fund to which tax-payers would contribute.   They would not pay more than the subscriptions payable to medical aids (it might even be less), but the government would then regulate medical aids before they received the funds due to them.   There would be some standardisation of benefits (this has already been introduced in the concept of Prescribed Minimum Benefits in relation to chronic medication) so that more people would enjoy the safety-net of medical aid.    What the policy intended to do was to prevent medical aids from the manipulation of their membership bases.   We are unaware of this, for the most part.   Medical aids with lots of older members pay out a lot more in benefits than those with a younger profile, thus being less profitable and more prone to higher annual increases.    Marketing strategies and various other means are cleverly used by some schemes to ensure that the bulk of their members are younger, and, therefore, healthier.  

As we have seen in recent times, medical aid benefits from the various schemes are almost impossible to compare and the average member needs a broker to help him make the annual choice of which scheme to choose.    A cynic might infer that there is a lot of deliberate subterfuge in this matter.    Additional products and services, for which members are paying through their monthly contributions, are often manipulations of the market rather than any sincere desire to offer members optimal health care.   Government’s earlier policy wanted medical aids to be differentiated on the quality of their service to their members and not on a range of other factors that bewilder people at present.  

I have to agree that national health insurance should not be seen as a means whereby more money can be accumulated in order to prop up an ailing public health service.  Indeed, at the present time, more money simply means more down the drain.    The service must be fixed first, and then the introduction of some more equitable funding model may make a great deal more sense.   There is another consideration.    It is equally applicable to education.   The achievement of equity should not imply the lowering of the higher standards, but, rather, the raising of the lower standards.   The former model C schools cannot be blamed for the state of inequity in education.   It persists because so little has been done to raise the standard of the poorer schools.  Similarly, depriving those who pay and pay a lot, for private health care, will not improve the standard of the public sector.  This has to be done by careful planning and efficient and committed implementation and management.

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