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Can NHI In South Africa Work?

Since the presentation of South Africa’s National Health Insurance (NHI) Bill to parliament on 1 June 2021, confusion reigns within medical aids, health insurance companies, and the average South African, who relies on the private health sector. Even more developed nations seem split on whether their national health insurance systems are meeting their citizens’ needs. Will South Africa’s effort be able to beat the odds?

Let’s first take a look at the national health insurance pros and cons reported by countries that have already implemented them. Is such a system feasible in South Africa?

NHI Advantages

  • Lower overall health care costs. The government would control the prices of medical care through negotiation and regulation. Since doctors would deal only with a single government agency, there could potentially be a decrease in administrative costs.
  • Boost the economy. Greater preventative care for all may reduce the need for emergency room visits, which would in turn reduce the cost of medical care.
  • Promote equality. Access to health care should be determined by an individual’s need, rather than their ability to pay the exorbitant medical fees. With lower overall health costs and standardised services, every citizen can have access to the same level of care.
  • Remove health-related barriers to education. Ideally, an NHI should create improved access to testing and health care solution, specifically for children that may not get access to the full benefits of education.
  • Improve social security. More widespread access to health care may prevent welfare dependency as more people could be able to maintain their health in their workplace. A National Health Insurance in South Africa may also help to support vulnerable groups like the elderly or women living in poverty.

NHI Disadvantages

  • There’s less financial incentive to stay healthy. Without co-payments, the general concern is that people might overwhelm emergency rooms and doctors.
  • Healthy people pay for the sickest. According to US studies, chronic diseases make up 90% of healthcare costs. This can mean that the sickest 5% of the population create 50% of total healthcare costs, while the healthiest 50% only create 3%.
  • Long wait times. Patients may face long wait periods for elective procedures as government funds would be focused on providing basic and emergency healthcare.
  • Decreased quality of care. If finances aren’t comprehensive enough or managed efficiently, doctors may cut back on care to keep costs low.
  • The reality of corruption. Can we rely on yet another government institution when so many of already established bodies have betrayed the public’s confidence? South Africans need look no further than the crippled condition of state-owned entities like Eskom and SAA. Sadly, this new NHI bill does nothing to assuage these fears.

What will National Health Insurance Look Like In South Africa?

The recent presentation and proposed actioning of the NHI Bill, the question posed in medical forums is: Is South Africa in the financial position to be able to fund such an effort?

For the moment, there’s a push for compromise between the two: health insurance and medical aid should still be available to cover the cost of treatments that cannot be covered under a South African national health insurance. However, once the NHI comes into full effect,

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