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Service delivery a bigger hurdle to the NHI than funding – economist

Artificial intelligence could reduce the reliance on human resources in the new health programme.

NOMPU SIZIBA: Earlier this month [July] cabinet approved the National Health Insurance Bill. This bill is set to be tabled in parliament before the end of the year. Essentially, the bill seeks to achieve a universal quality healthcare system for all South Africans, regardless of their class or standing in life – a noble intention indeed.

However, a report published by Genesis Analytics on the NHI pilot programme, which began in 2012, suggests that, while close on R5 billion was provided to the project, there were no monitoring and evaluation mechanisms put into place to review progress, and in many instances funding for those special pilot sites was underspent. The report concludes that it would have been difficult for the government to make the assessment of whether there was a return on the investment made.

Well, to discuss the pros and cons of NHI as it gets closer to becoming a reality through the parliamentary process, I’m joined on the line by Dr Anban Pillay, the deputy director-general for NHI in the National Department of Health, and Dr Adrian Saville, chief executive of Cannon Asset Managers, who is also an economist.

Thank you very much, gentlemen, for joining us. Let me start with you, Dr Pillay. Many people are worried that here we have a very noble cause in the NHI, but the economics of our country right now just don’t stack up to being able to support it. What mechanisms are you going to be putting into place as government to make this ambitious project succeed, and what are the implications for private medicine?

ANBAN PILLAY: Good evening to you and to the listeners. I think it’s important to recognise that the National Health Insurance is a project that’s going to be phased in. It’s not anything that will happen within a day. The implementation of the project will happen over months and years. Our estimated time frame is that the project will be completed by 2026.

The idea is to bring the funding from the public and the private health systems into a single pool and, using the state’s ability to procure goods and services at scale, be able to achieve efficiencies in terms of those costs; at the same time to be able to achieve the redistributive efficiencies between rich and poor – so that we are able to allocate resources in a manner that does not differentiate between the wealth of South Africans – and provide them with a basic health package of good quality which will be appropriate for all South Africans.

NOMPU SIZIBA: Dr Saville, as I say, it’s a noble thing, trying to have this universal healthcare for all South Africans, regardless of their standing in life and so on. But when you look at the government’s plan so far, do you think it has a plan in place, and can we afford it?

ADRIAN SAVILLE: There is a plan in place, there is no question about that. Do we have the ability to afford it? I would venture yes, we actually do. Funding is not really the issue at stake here. What is at question is the ability to deliver the service. Here we need to be clear that it is not about the public sector delivering a public service – it’s about making funding available to a service that can deliver what’s promised.

Beyond noble, I think it is in part extraordinarily ambitious but, in the same breath, incredibly important. You can’t possibly build a viable, competitive economy on the back of a society that is not well. That is certainly the diagnosis of South Africa. We have low life expectancy, high infant mortality, high rates of HIV/Aids prevalence, tuberculosis, work absenteeism – high for a country of South Africa’s income status.

NOMPU SIZIBA: Dr Pillay, there are huge concerns about basic human resources in the form of doctors and nurses. I read somewhere that in the next 15 years or so some 50% of the registered nurses we have in the country will have retired, or will be retiring. How do we grapple with this very real human-resource challenge, because it’s a specialised type of skill that we need, especially when many of our health workers continue to be lured by better offers in other parts of the world?

ANBAN PILLAY: It’s important to recognise that in terms of human resources it’s important for us to increase the production of human resources so that we create more people available to deliver services. But, secondly, we also must think more smartly about how we deliver services. In many countries they’ve moved to health systems that are not human-resource intensive. For example, in the UK we have a model where a patient will call into a call centre, and on the other side of the line is a clinician as well as a specialist, if necessary, who go through a series of questions assessing that patient and determining where a patient should go. So, the human resources, the way they are currently structured and delivering services, can be improved in terms of efficiency.

But we agree we need to increase significantly the production of human resources, and so there is a human resource plan to do that exactly. But I do think we also need to embrace artificial intelligence and all the novel ways of delivering healthcare so we can reduce the high reliance on human resources.

NOMPU SIZIBA: Our thanks to Doctors Anban Pillay and Adrian Saville for their time today.

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NHI will be the ANC’s biggest mistake yet – and they have made a number of really big ones. The Eskom bailout is a prime example. Money is being poured down a big black hole. This will solve nothing.

But you are looking at things from an honest playing field Taffy. For the ANC (elite) the Eskom situation and bailout is a massive success. Huge loot into cadre pockets and Luthuli House, many cadres employed and tenderpreneurs making millions, if not billions.

That is what NHI will be; it is just a crooked scam to benefit the ANC elite in a different package to Eskom. Same outcome.

AGreed Taffy but not a mistake in ANC speak; it has been a fantastic success. Many billions paid to ANC cadre employees, tenderpreneurs and Luthuli House. The bailout keep the flow going.

The ANC “plan” for NHI is exactly the same.

The purpose of the NHI is to retain the ANC’s hold on power. Like social grants and free HIV medicine it is an ostensibly noble policy to increase everyone’s dependence on the state.

One thing after the next just shrinks the tax base further.

They don’t understand numbers so its to be expected.

They think the middle class will just stick around and keep paying. I dont think so.

I stopped reading when Anban Pillay commented “…into a single pool and, using the state’s ability to procure goods and services at scale, be able to achieve efficiencies in terms of those costs;…”

NOPE. I very much DOUBT if the state has ANY ABILITY left to produce ANYTHING at scale.
Examples?

ESKOM is a MONOPOLY producing 90% of SA’ power, yet they are UNABLE to be profitable. Their debt now equivalent of 7 US Navy aircraft carriers’ production cost….and Eskom’s debt gets WORSE by the month. No hope!

SAA? Currently flying into the ground…been bailed out on annual basis. Losing billions. Also, the largest airline in a local duopoly.

DENEL? Shooting themselves in the foot financially. Also making losses into the billions.

Wait….magically…the NHI will be a success!

(If there’s supposedly no NHI-funding issues, why not use those funds to help Eskom to regain it’s spark to get out of the dark hole.)

NHI will be as successful as Workmens’ Compensation and Road Accident funds.
Doctors will be bankrupted by slow payments and be forced to leave. Followed by anybody who values health care as part of his/her family’s life.
It’s inevitable, based on the track record of those trying to implement it.

An unbelievable disaster approaching like a hurricane. Hopelessly short of doctors and nursing staff. You can mostly treat a disease, no cure for stupidity

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