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“Free healthcare for all” is the most ambitious goal contained in the South African National Health Insurance proposal. The South African Private Practitioners Forum (SAPPF) supports the notion of Universal Health Coverage and agrees that all South Africans should have some form of health insurance. However, they question the validity of government attempting to provide “free healthcare for all”. A better aim would be to determine the best way to increase access to quality healthcare for the poor.

The SAPPF’s view is that the proposed NHI scheme is thick on ideology and thin on practical detail. Government should use the same framework that it applies to other constitutionally mandated objectives such as housing and education where the state cares for the indigent and leaves the voluntary private market alone. To minimise the state’s responsibility, the private sector should be deregulated while government concentrates on using scarce taxpayer resources to pay the premiums for the poor, rather than trying to insure the entire nation.

The “uncertain” funding sources proposed in the White Paper will be difficult if not impossible to implement. Government should use funds already at its disposal and not impose further taxes on an already overtaxed population. Proposed mandatory payments into a central NHI Fund will crowd out private insurance as many individuals, unable to pay voluntary private insurance premiums as well, will be forced to move to an already over-stretched, public health service.

Even developed nations have attempted but not succeeded in providing free healthcare for all through a single payer model. The NHI is a grand idea, poorly conceived, that seems more concerned with removing the so-called “two tier system” rather than finding an affordable mechanism to improve access to quality healthcare for the poor. The state does not have to provide “free healthcare for all”. It should rather focus on those who need but cannot afford to pay for healthcare and leave the rest of the population alone.

In 2013, the Baseline Audit for Government Health Facilities, covering 3,880 facilities, revealed a grim picture as only 32 complied with infection control guidelines; 25% of clinic staff had a positive and caring attitude; 93% of maternity facilities did not have the necessary equipment to ensure mother and baby treatment safety; and only two could guarantee general patient safety.

The 2014/15 national Inspections of 417 facilities by the Office of Healthcare Standards Compliance showed that 3.1% of facilities were considered compliant; 13% were conditionally compliant; and 67.6% were non-compliant or critically non-compliant. The NHI white paper states that “Health facilities that meet nationally approved standards will be certified by the Office of Health Standards Compliance to render health services”. If this office performed its mandate with these inspection results, only 16% of public health facilities would be operational in the NHI.

The data being used in the NHI policy papers to try and justify radical changes is not correct. The Minister of Health indicated that, to have 80% of specialists serving 16% of the population in the private sector is, in the view of his department, an inequitable distribution that the proposed NHI aims to rectify. However, research figures published by Econex in 2013, used in the Department of Health’s own Human Resources for Health publication, show that between 28% and 38% of residents in South Africa utilise private healthcare; 41% of specialists work in the public sector and 59% work in the private sector.

The NHI will act like a huge medical scheme. When compared to the Compensation Fund which currently receives about R8-billion a year in income and has R52-billion in assets, most of which is administered by the Public Investment Corporation (PIC), employs 1,630 people and, last year, paid out R1.4-billion in medical claims, the NHI budget is 32 times larger, total claims payable are likely to be 100 times more, not including paying suppliers, and it will need between 52,000 and 160,000 employees. If the Government is unable to run an R8-billion fund efficiently, how will it manage a R256-billion fund?

The famous US satirist PJ O’Rourke summed up the situation succinctly when he said, “If you think healthcare is expensive now, wait until you see what it costs when it’s ‘free’”.

Issued by Free Market Foundation