WORLDVIEW: Why the NHI is a dead duck. A reminder to first get the basics right.

Seeing up close the pressure the UK is under to maintain its National Health Service makes one wonder whether the proposed South African equivalent was ever anything more than a promise to catch votes. Especially when you consider the British earn, on average, seven times that of South Africans – and contribute a higher percentage of their earnings in taxes..My Biznews colleague Chris Bateman has taken another look at the concept and writes: "South Africa's much vaunted universal healthcare scenario, called NHI, is fast becoming an impossible dream. A contracting economy, the growing quadruple burden of disease and an ongoing human healthcare and hospital beds resources crisis is seeing to that..Saying universal healthcare is the right thing to do means nothing when it comes to the pragmatics of delivery and creating capacity. It's now more than ever, a case of "show me the money" despite National Health Minister Dr Aaron Motsoaledi's assertion that "we can't afford not to have an NHI"..___STEADY_PAYWALL___.Perhaps he's now considering this: the latest conservative (Econex) estimate is that by 2025/2026 the NHI, as envisaged would generate a budget shortfall of more than R200 billion. That's based on revised GDP 'growth' estimates since the NHI White Paper's then-conservative 2% GDP growth projections..According to Econex, the public health budget is projected to increase from 4.2% of GDP to 6.6%. To finance the estimated cost of R256 billion a year for the NHI by 2025/26, the public health budget will have to increase by more than 10% annually from 2019/20..Here's the killer evidence: There are no discernible large budget increases for NHI funding in the near future; the February 2016 medium-term budget expenditure estimates show very little expected increase in the national health budget as a percentage of GDP up to 2018/19, in real terms..Given the literature on insurance-induced pent-up demand and South Africa's unique quadruple burden of disease, much larger utilisation increases are to be expected than current assumptions allow for..In case you need reminding, the quadruple disease burden consists of; an HIV/AIDS epidemic alongside a high burden of TB; high maternal and child mortality; extreme levels of violence and injuries, and burgeoning Non-Communicable (lifestyle) Diseases. Yet the country does not currently have the infrastructure to even cope with just chronic diseases..Factor in SA's healthcare staffing crisis and facility constraints, add a touch of cadre deployment (read dysfunctional management), rampant healthcare unions and soft-spined healthcare MEC's bent on placating them, especially at election time, and it's hard not to conclude that, as things stand, an NHI is unworkable..Nothing happens in isolation and until the system of patronage, corruption and the common political penchant for blaming the very physicians who make healthcare delivery possible changes, I doubt we'll see a functioning NHI anytime soon. That it should happen, given that 80% of the population rely on State healthcare, remains a given.".Great stuff as ever from Chris. NHI is clearly unaffordable. For now anyway. First, the country must eliminate the wastage caused by corruption and the growing tax gap. It's always best to get the basics right before attempting the grandiose..Comment from Michael Eliastam, based in the United States.Chris Bateman's analysis is excellent, to my mind, exactly right. I just spent 3 months in SA, in the private sector as a patient after a bad fall in Nairobi requiring surgery in Cape Town. During this 3 month stay when I read a lot of local news, I was struck by comments by NHI leaders that sounded like a desire to disrupt the very good private sector to 'equalize' the overall health delivery system. While I sometimes like what Julius Malema says, when he starts his diatribe on taking away the land from the whites, his desire sounds similar to this proposed disruption of the existing healthcare system. The South African challenge is to shore up the about to collapse dike, which is the public health care delivery system. Destroying the private sector is an absurd answer.

WORLDVIEW: Why the NHI is a dead duck. A reminder to first get the basics right.

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