NHI, Medical Schemes and the Health Commission

nhi medical schemes and the health commission

Everybody’s talking”. Remember the song that was sung by Harry Nilsson in 1969?

Well, yes, everybody is also talking about NHI, medical schemes and the Health Commission of Inquiry.

Information overload? Indeed.

There can be no question about every level minded person wanting and supporting NHI.  But, there is an important question to consider – one that everybody seems to be missing… how is what the NHI Act contemplates different from what we have at present?

Think about it for a moment.

The truth is that we have NHI at present.  Every procedure in a public hospital is billed according to the Uniform Patient Fee Schedule (UPFS).  This means that every patient in a public hospital that undergoes the exact same procedure will receive an invoice for the exact same amount based on the UPFS tariff.  However, not every patient will pay the same amount.

Patients on medical aid or earning a higher salary will get no rebate and will pay 100% of the UPFS tariff.  The indigent and those earning lower salaries will get rebates ranging up to 100%.  This means that the poor do not pay for treatment in a public hospital.

So, what does NHI contemplate then, other than the rich subsidising the poor? Because that is exactly what is happening now.

The “rich” pay taxes.  Taxes are allocated to healthcare to maintain public hospitals where the “poor”, that pay no tax, receive free treatment.  Yet, the Minister of Health recently stated that the poor are paying for the healthcare of the rich.  This outrageous statement is completely misleading.

In the NHI Bill the only reference to doctors is about subjecting them to price control, registration or excommunication.  In reality, however, the entire healthcare system revolves around doctors; not the other way around.  Without doctors we have nothing, yet, the Bill makes no reference to “looking after our doctors”.  Doctors, who spend more than seven years qualifying and who get up at all hours to save lives whilst all others are fast asleep, will be expected to work for a fixed income whilst Steinhoff is paying experts a reported R5.4 million a day to sort out its financial mess!  How many lives are they saving?

But wait, it gets even worse.  Generally, in all corporations, salary levels are determined by qualification, experience and ability to do a job.  That is however not the case in the NHI Bill, where it is proposed that all doctors should be paid the same rate irrespective of seniority, experience or ability.  A first year intern will therefore earn the same fee as a surgical resident.  How rational is that?

According to an article recently published by the Solidarity Research Institute, more than 80 % of healthcare workers believe that health practitioners will leave South Africa if government steams ahead with the roll-out of the NHI.

The answer is not blowing in the wind.  Public hospitals need the same excellent management we had a few decades ago.  Not the kind of management that we currently have, where, according to the latest Office of Health Standards Compliance report, only 5 of the 696 hospitals and clinics it inspected complied with the Department of Health’s norms and standards to achieve an 80% “pass mark.”  Note, 80% is acceptable and not 100% that should be expected in healthcare!

Underlying our multitude of public healthcare problems and inefficiencies is the reality that the state seems to be incapable of executing any plan properly or applying policies correctly and efficiently.  The deceitful promise that NHI will solve our public healthcare crisis against the existence of unproductivity, corruption and incompetence is an insult to every citizen that has the right to quality healthcare.

We simply cannot afford to experiment with healthcare.  Healthcare is not a manufacturing plant where a faulty batch of product can be destroyed.  It is about people and mistakes cannot be made.  The current problem has to be fixed and government should stop at nothing, especially not egos and political or racial or any other overtones and excuses, to ensure that every citizen has an equal opportunity to receive a decent standard of healthcare.  The system is in place right now.  It needs competent management and not a smokescreen that will hide the mess.

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