Journey to universal health insurance, NHI, gains speed

 South Africa was not alone in its quest for universal healthcare said a US specialist in his appraisal of the National Health Insurance (NHI).

John E McDonough, Director for the Centre for Public Health Leadership at the Harvard School of Public Health in the United States was addressing the Bonitas and South African Medical Association Doctor’s Conference and Exhibition held in Johannesburg last week.

He said 25 of the wealthiest countries, except the US, boast universal coverage, while some middle income and even low income countries, have been working towards blanket coverage for most, if not all, of their populations. This is because over the past two decades, universal healthcare has moved from being a moral imperative to being recognised as an investment in productivity and therefore economic growth.

He noted that like South Africa, the US spends a considerable amount of resources yet does not achieve the desired quality health outcomes. Of the world’s seven most industrialised economies, the US devotes the highest proportion of resources as a percentage of GDP to healthcare yet still experiences poor outcomes on a range of measures including access, equity and affordability. This points to the need to eliminate wastage and inefficiency in the NHI.

Anban Pillay, the deputy director general for health regulation and compliance at the Department of Health, said the implementation of the National Health Insurance (NHI) continues to gain momentum. The NHI white paper was expected before the end of this year and the business plans for the 11 pilot sites and seven central hospitals in the R 1 billion pilot phase have already been finalised. The first five years of the NHI are focused on revitalising hospital infrastructure.

McDonough who was an integral part of developing the 2010 US’s national health care plan, the Affordable Care Act, or ObamaCare, said the US was forced to undertake health reform because of unsustainable cost increases. The country already has the most expensive system in the world, with 50 million of the total 310 million population without any medical insurance, while a significant number remain underinsured.

Apart from a national health insurance being a global phenomenon, McDonough also notes that healthcare reform “is hard work”. What South Africa also needs to know is that failure is an option or rather a distinct possibility, he says.

He points to former US president Bill Clinton’s attempts at healthcare reform in 1993, which failed dismally, as being the roots of success for the current wave of reform undertaken in 2008.

McDonough says while all sections of the population may agree on the need for universal coverage, finance becomes a sticking and dividing point when parties have to decide how the burden is to be shared.

On the conference sidelines, McDonough advises South Africa not to be fazed by exorbitant cost estimates, such as the late economist Tony Twine’s assertion that at full implementation, the NHI will cost 28% of South Africa’s GDP.

“Ignore those estimates”, McDonough says, “a country will never design a system that takes up a third of its resources for healthcare”, he concluded.

André Meyer, CEO of Medscheme, says “It is heartening to see that South Africa is on the correct course in its pursuit of a universal healthcare through the NHI, whose underlying principles Medscheme supports.”

“Some of the measures that we have undertaken, such as developing an extensive service provider network are designed to help achieve some of the goals of the NHI. We will continue to support the NHI’s goal” said Meyer.

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