Public statements made recently by Dr Nicholas Crisp, deputy Director General of National Health Insurance (NHI), entirely define the populism and socialist ideology espoused by the ruling party, the ANC.
In his insistence that government will not be backing down from implementing NHI, Crisp equates the problems in our world class private health sector to those of the public health sector. This stance of denigrating the private sector, even against overwhelming evidence that the private sector is much more capable than the state, is a mainstay of ANC socialist ideology in order to garner as much control of the economy as possible.
Crisp laments the current situation as deplorable, as justifiable reasons to implement NHI, which requires the nationalisation of the private health sector and the collapsing of it simultaneously with the public sector into this brand new public health system, the NHI.
While Crisp’s argument that the private sector is expensive is valid, he flatly ignores that the public health sector is where it is now because of gross mismanagement on the part of the government. Rather, he trots out the usual contention that public sector woes are because of underfunding, arguing that with plenty of additional NHI taxes – about R175bn extra annually according to the two NHI white papers (2021 values) – government will do much better in delivering quality healthcare.
This apparent insufficiency in public health sector expenditure has often been decried by government health officials, deploying it as a convenient scape goat for poor public sector outcomes. However, the financial reality on public expenditure is far different from what is projected by health bureaucrats. A paper published by National Treasury in 2017, showed South Africa’s public health budget has been growing substantially for two decades. Taking these figures, along with the last few Budget Reviews from Treasury, the real per capita public health expenditure in 2019/20 was nearly double what it was in 2000/01. This same publication revealed how the state was thus able to employ many more medical personnel, increasing the number of filled medical posts by 43% between 2006 and 2016.
With such dramatic increases in both financial and human resources over an extended period of time, where are the improvements in the quality of care and the health outcomes?
There are 55 countries, including SA, that are classified as upper middle income countries. On average their public health expenditures equate to 4.1% of their GDP’s or an equivalent per capita weighted amount of $279 pa (2018 values). SA’s public health expenditure is also 4.1% of GDP and expenditure (also in 2018 values) was $260 pa. This places our public health expenditure at a very similar level to our peers, yet when evaluating health outcomes, we rank near the bottom of this country grouping.
The reality is that our poor public sector quality has got far less to do with underfunding than the usual South African suspects of poor management, maladministration, incompetence, cadre deployment and corruption.
Crisp also ignores that the private sector has a blueprint to bring about affordability – the findings and recommendations of the Health Market Inquiry – and which does not necessitate NHI intervention. But the government does not like the findings of this Inquiry, as the panel were highly critical of government in their failings to adequately regulate and implement proper policies in the private health sector over the past two decades, which partly lead to the unnecessary rise in private health costs.
Rather, Crisp would have us believe that his employer, infamous for the destruction of virtually every public sphere over which it has governed, not only holds the sanctimonious right to nationalise the private health sector, but also possesses the capacity, skill and knowledge to amalgamate the country’s two health sectors as one in the NHI and build a world class national health system.
His most populist claims, and subsequently the most improbable, are that the NHI will make comprehensive health services available to every citizen in the land, which will be delivered at zero cost to patients at the point of service. It is important to note that this has never been achieved in any health system anywhere in the world!
Yet Crisp maintains that our ANC government, the one of state capture notoriety and of exhibiting precious little progress towards becoming an ethical and capable state, is going to build such a national health system, unequalled in any other country.
If the destructive ramifications of this calamitous NHI proposal were not so serious, Crisp’s assertion of achieving global superiority would be laughable!
Clinical audits by the Office of Health Standards Compliance on public health facilities – community centres, clinics and hospitals – since 2017 show a very poor, but consistent, clinical compliance status of less than 15% nationally. This means 85% of public health facilities do not meet basic minimum clinical standards. In the latest audit report of 2019/20, five out of 199 health facilities audited in the Northern Cape and Eastern Cape achieved compliance and, in the Limpopo and North West provinces precisely zero out of 135 did.
This clearly explains why the government now has a liability for medical malpractice legal claims of more than R120bn – almost half the entire national health budget. In the Eastern Cape, the province that most embodies the ANC’s governance failings, and likely the worst run health department in the country, the medical malpractice liability now exceeds the entire annual provincial health budget.
If the ANC was sincere in wanting to improve public healthcare, it could easily have done so a long time ago by overhauling existing public facilities and installing qualified non-cadres capable of skilled facilities and clinical management. The state had access to the financial and human resources by which to do so, and it would not have had to wait years to try and legislate a complex policy proposal, such as the NHI, to do it.
But when attempting to assess the rationale justifying this NHI proposal, contrasted against the critical details outlined above, the only conclusion is that there is no rationale other than to give the ANC the ability to chase the very, very big money pot, that will be filled with plenty of new NHI taxes and waiting at the end of the NHI rainbow for ANC cadres to feed from.
The views of the writer are not necessarily the views of the Daily Friend or the IRR
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