National Health Insurance (NHI)
Opinion By | Tiisetso ‘Afrika’ Makhele
“The NHI is an important instrument to tackle poverty. The rising cost of health care makes families poorer. By contrast, health care provided through the NHI frees up resources in poor families for other essential needs. The NHI will make health care in the country as a whole more affordable” – President Matamela Ramaphosa, 15 May 2024
In 1944, the then illegitimate government of South Africa made a strenuous attempt to implement a policy of universal healthcare coverage, akin to that implemented in the United Kingdom at the time. The failure to implement the above policy was not caused by budget constraints, as many colonial propagandists argue. The main challenge was the lack of a legislative basis to exclude blacks in general, and Africans in particular, from quality healthcare provision.
It was only after 1948, when Apartheid was legalized, that the state developed the means to achieve the end intended to be attained in 1944. Using various legislations, medical aid schemes were modelled as a tool to ensure specialized healthcare provision for whites, in a country where blacks are a majority.
The consequences of the above are still prevalent even today, with whites being less likely to require or need public healthcare. In the current scenario, both the state and income earners enjoy better health services, which is offered by the private sector, because of less demand as well as subsidies from the state, while the majority, which include foreign nationals, flock the strained public health facilities.
The signing into law of the National Health Insurance is a positive step towards the realization of the ideals contained in the Freedom Charter, which stated, amongst others;
• A preventive health scheme shall be run by the state; and
• Free medical care and hospitalisation shall be provided for all, with special care for mothers and young children.
The National Health Insurance, sometimes called Social Health Insurance or Mandatary Health Insurance, is universally accepted as a type of insurance that cushions the health users from the costs of healthcare and health insurance. Due to the historical development of healthcare in our country, access to healthcare, and nature of healthcare is influenced by race, gender and class, Blacks, and African women in particular, are likely not have access to quality healthcare because of our unique history.
The NHI therefore is a revolutionary policy that seeks to reverse the legacy of Apartheid and colonialism, by ensuring that all South Africans, irrespective of gender, race and class, have access to the same or similar type of healthcare. Many South Africans are not aware that currently, medical aid users, especially high-income earners, receive substantial tax subsidies from the state. These incentives are not little money. In 2005, they amounted to R10 billion, or about 20% of the entire public spend on healthcare.
This essentially means that the rich have access to some of the best doctors thanks to the state. This is anti-poor and must be changed. I believe this is one of the areas that the NHI wants to address. Secondly, private medical costs have skyrocketed in the recent past and this, added to the co-payments demanded by medical aid schemes, have made healthcare inaccessible to many, including those with reasonable incomes.
The NHI is a welcome platform to ensure access to quality healthcare for all. The law will counter the ongoing commodification of healthcare by making sure that the state controls the financing of, and access to healthcare by all the people, black or white, rich or poor.
Makhele is an African Marxist and a public sector economist. He writes in his personal capacity
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