Addressing inequality through health for the poor

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WORKERS in the public healthcare sector need to part of the discourse on the National Health Insurance, says the writer. Pixabay

Those reading these words are almost more likely to have secure access to private medical care, medical aid or some sort of hospital plan. Regrettably over the past few months, we have see a barrage of articles and opinion pieces all coming out, in the main, squarely against the national roll-out of the National Health Insurance. 

Yet none suggest a manner in which we can adequately address the widening gap between the inequality in healthcare and medical attention in our country. Instead what we have witnessed is a digging in their heels of the middle class who refuse to let go of their health enclave in which they have been secured themselves because of their own resources. As a result, once again, the inertia to address the gross inequality in our country has been laid bare on the operating table.

In line with the thinking of Albert Hirschman, in “Exit, Voice and Loyalty”, the middle class have simply exited from the public health service. As with their security, schools, water, electricity and other public services, they have simply opted out and as a result have not been willing to subsidise those dependent on these public services. 

Two years ago, the Department of Planning, Monitoring and Evaluation issued the Final Impact Assessment (Phase 2) of the Socio-Economic Impact Assessment System (SEIAS) on the White Paper on National Health Insurance. In that assessment it was pointed out that whilst just under nine percent of our country’s gross domestic product was spent on health care and comparable to other middle income economies, only four percent, of this nine percent of GDP, was spent on eighty-four percent of the country’s medically uninsured population. 

In other words, sixteen-percent of the country’s population was spending more, albeit by a percentage point, than eighty-four percent of the population on healthcare. The inequality could not be more stark. 

What the NHI therefore primarily seeks to do is ensure that there is an equitable approach to resource allocation given the fragmentation, underfunding and misalignment of resources in the private and public sectors. The system will guarantee that there is a progressive universal approach to the right to health but will also imbue social solidarity, cross subsidisation, justice and fairness in a health system that seeks to be unified and integrated. 

The eighty-four percent of the population who are not covered by the medical schemes will, as a result, benefit the most and NHI will cover all irrespective of socio-economic status while also addressing the gaps in the national health system. Simultaneously, those of the sixteen-percent of the population who do have access to medical coverage will now have access to a comprehensive coverage approach instead of the current fragmented benefits that they enjoy. 

The benefits of a more healthy population are evident with estimates suggesting a year’s increase in life expectancy which may increase GDP per capita by four percent while labour productivity can see an increase of between twenty and fifty percent in the medium to long term. 

Those jobs said to be potentially lost in the private sector will be absorbed by the public sector. The unequal fiscal federal system of fund allocation to provinces perpetuates unequal distribution in fund allocations whereas a national pooling of funds will see new roles for the provinces in terms of health provision. 

The cacophony of objections in the last few days are simply by those who object to addressing these inequalities. The Health Professionals Council of South Africa, Pharmacy Council, South African Nursing Council, Allied Health Professions Council, Council for Medical Schemes are all professional organisations, in the sector, who have come out in support of the NHI. Even the big pharmaceutical industry is said to give conditional support while it is only the medical schemes and administrators and the private hospital groups that do not support the system. 

Civil society, patient advocacy groups, academics from Stellenbosch University, UWC, UCT and WITS have all come out in support of the NHI. One then wonders where this noise about the supposed effects the NHI will have on the fiscus and the chorus opposition really comes from. NHI is a manner in which we urgently address inequality and we who read these words must support it. Our future depends on it.


Wesley Seale is a PhD student in Beijing.