Doctors love abbreviations. In fact modern medicine thrives on them. Your heart attack is an AMI (Acute Myocardial Infarction), your stroke is a CVA (Cerebrovascular Accident), and your cancer is NHL (Non-Hodgkin Lymphoma). These terms form part of a language medical professionals understand, and you the patient do not. So with that said allow me to introduce you to the great equaliser, the NHI (National Health Insurance).
It is quite clear from recent media coverage that journalists are still grappling with the true meaning of the NHI, and based on my discussions with doctors from a junior to a senior level there is even less understanding among medical professionals. Given this background I would have to be either extremely arrogant, frightfully stupid, or perhaps both to assume to be the expert on the proposed system.
Our Minister of Health, Dr Aaron Motsoaledi, would have you believe that there is no other option, that private healthcare is unsustainable and that public healthcare for all is the only way forward. Most people are inclined to side with anything the Minister says because they’re still so excited that a drunken bigot isn’t controlling our health system. Don’t get me wrong. I’m a fan of the Minister, he says the right things at the right times to the right people, but then again so do well versed politicians.
In reality it is too early to say what the NHI will mean on a detailed level somewhat because it will only be fully implemented in 14 years time, but mainly because government’s green paper doesn’t actually detail very much. In essence we currently have a national health system, any patient can walk into any public clinic or hospital and will receive treatment. There is however a catch to the aforementioned. There are not enough clinics or hospitals, there is not enough equipment and there are not enough staff. This is specifically the case in rural areas and townships where health needs have grown far beyond expectations. The simple solution is to increase funding to the public health system that we already have in place, however there isn’t enough money in the fiscus to fund the staggering changes needed to fix all the problems. That’s where you come in, assuming you’re a taxpayer, it’s you who is going to be forking out for all those new hospitals and all that new equipment. Of course this will result in several consequences, those for the system will argue that overall, the pros outweigh the cons; that new infrastructure and a better managed system will mean improved results. On the other side of the argument one of the likely cons of the NHI is the almost certain destruction of private healthcare, at least in its current guise.
The socialist within you may want to argue that private healthcare doesn’t have a place in our society. That National Health is the way to go so that we achieve equality for all in the area of Medicine and allied healthcare. This may all be correct except for one significant factor – doctors.
South Africa produces some of the best medical practitioners in the world. Contrary to popular belief the most talented doctors are not necessarily those working in private. There are brilliant doctors in public settings, and some of the best working in both simultaneously. The private sector does have one clear advantage over public, in that it encourages far more competition. Patients go to doctors who have good reputations and equally good outcomes. They have freedom of choice.
The NHI will however result in the overwhelming majority of doctors, if not all doctors, working for the state. This means no competition. All doctors get paid the same and are incentivised the same regardless of where they work, how good they are, and most importantly how good their patient outcomes are. As a patient you get no choice as to who your doctor will be. Much like the public education system a teacher with exceptional pass rates will be rewarded in the same way as a teacher with shocking failure rates.
In the long term this will create an environment which does not attract the best doctors, and even worse does not incentivise doctors to be as good as they can be. A situation where the doctor with great potential wonders why he should try to excel or why he should even care when the next guy doesn’t and receives the same remuneration (financial and otherwise).
The bottom line of NHI is that just like many medical abbreviations it has terrifying consequences, and its meaning isn’t as simple as National Health Insurance. Its meaning is something far more dangerous to our society – mediocrity.