NHI Bill is a ‘charade’ that will collapse eventually, says BLSA

The passing of the “unworkable” National Health Insurance Bill by the National Assembly is “yet another act in a pantomime that government seems intent on performing”, says Busisiwe Mavuso (pictured), the chief executive of Business Leadership South Africa (BLSA).

Writing in her weekly newsletter, Mavuso said it will be impossible to implement or fund the bill’s provisions. Despite this, the government is intent on proceeding, “ignoring that eventually the whole charade will collapse”.

What the NHI Bill envisages – the shutting down of almost the entire private healthcare system and its replacement with a government scheme – is impossible, she said.

She said the lack of outcry over the passing of the bill indicates many people have given up caring about it.

“They know the emperor is wearing no clothes, but scarcely anyone considers that remarkable. They will go about their business content that this performance will come to an end with South Africa no further down the line in improving access to healthcare for all.”

Although the legislation is unworkable, Mavuso said it will have negative consequences.

“National Treasury will be forced to appear to be attempting to find a way to fund it, despite the fact that there are myriad other demands on it for funding that cannot be satisfied as it is. The health system will be forced to appear to be implementing it, setting up the required boards and committees, despite the fact that its existing facilities are in urgent need of attention and most of them fail to meet basic standards. This will be destructive to government functioning as scapegoating breaks out amid frustration with delays. On top of that, there is inevitably going to be a raft of court cases as people and businesses affected take action to protect their rights.”

Mavuso said business was willing to work with the government to find the best possible way to put the country’s scarce resources to work in improving health access for all.

“A plan that is backed by a consensus view across business and government would galvanise all partners to drive its implementation. That is the scenario for our health system that I hope we can realise.”

‘Devastation is no obstacle’

Meanwhile, Dr Nicholas Crisp, the deputy director-general for NHI in the Department of Health, has acknowledged the broken state of South Africa’s public hospitals.

“There are parts of the country where management is abysmal, where political interference is seriously problematic, where there is devastating abuse of the system, and high-profile theft and fraud,” he told Chris Barron of the Sunday Times.

Asked whether NHI could be implemented on top of a broken public health system, Crisp said: “Yes, absolutely. When other countries have built their NHIs, they’ve largely built them in devastating circumstances.”

Questioned why public hospitals haven’t been fixed, he said: “I don’t see how it’s possible to fix things spending R5 200 per person per year.”

Asked how the department planned to prevent corruption from destroying NHI, Crisp said that was like asking “how you’re going to prevent patients from stealing from their medical aids”.

Asked how the department will protect the NHI Fund, which will spend an estimated R500 billion to R700bn a year, from criminal networks, Crisp said he doubted the fund will have more than R400bn and added: “You work hard to simplify the systems and make them transparent. You intervene when you flag these things.”

Asked where the money to fund NHI will come from, he said: “We spent R277bn the year before last in the private sector. If you add that to the R265bn we spend in the public sector, the money’s already there.”