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NHI plan will create another state monopoly, warns Wits professor

Have we not learnt from the failures at Eskom and Transnet? Watch Professor Alex van den Heever share his concerns.
Creating a 'monopoly purchaser' of healthcare drugs could open the system to ‘grander scale corruption’, says Professor Alex van den Heever. Image: Shutterstock

Concerns have been raised that the government’s plan to set up a National Health Insurance (NHI) scheme will result in another state-run monopoly that will be susceptible to greater levels of corruption and mismanagement.

These fears have been voiced by Alex van den Heever, an adjunct professor at the University of the Witwatersrand (Wits) School of Governance, who was one of the speakers during a panel discussion on the NHI at the SA Vision 2030 Summit in Ekurhuleni last week.

Read: South African taxpayers will bear the brunt of the NHI

Van den Heever, who is chair of Social Security Systems Administration and Management Studies at the Wits school, is a vocal critic of the NHI and has more than 25 years of experience around public healthcare policy and advocacy.

“Tenders and the existing framework in government healthcare have also been affected by a system of patronage, which is already endemic in the current system,” he said.

“A new government monopoly – in the form of the NHI – is not going to solve the problems in healthcare.”

Watch: Professor Alex van den Heever shares his NHI concerns

“Besides the huge costs associated with the NHI, I believe the plan will create another state-run monopoly that is destined to fail and become racked by some of the corruption and state-capture issues the likes of Eskom, Transnet and other state-owned enterprises (SOEs) have faced in recent years,” he added.

Read: NHI roll-out cost increased by additional R33bn a year

And: Health plan is affordable, won’t add to debt – health minister

Van den Heever noted that the NHI plan includes the mass purchase of various healthcare drugs. “The state is already a major buyer of drugs. With the NHI, we will create a ‘monopoly purchaser’, which could open the system to grander scale corruption, like at Eskom.”

He believes that while the SA healthcare system needs reforms, improvements can be achieved “incrementally over time” with more accountability and policy regulation, rather than through “one big monopolistic state-run national plan”.

“We need to get the basics right and the current health system working for ordinary South Africans,” he said.

“There needs to be reforms in the health department at national and provincial level as well as within the private healthcare sector, but we can’t have one big plan and wait for the NHI to sort things out.”

Responding to Van den Heever’s criticisms at the summit, Dr Nicholas Crisp, an advisor to the Department of Health on the NHI, said that a major overhaul of the whole healthcare system in SA is needed.

Read: The future of SA healthcare is uncertain

“Pharmaceuticals is just one area, but it is not the main reason for the NHI.… Some 45 million South Africans are not getting adequate healthcare and we are seeing more unhappiness with increased service delivery protests around the country. We hope to help turn the tide with the NHI,” he noted.

“Even for people who have medical aid, there are challenges.… You have to ask: are they happy to have medical aid increases of 11% this year? They are not even getting salary increases at that level, so are also facing higher healthcare costs,” he added.

Crisp conceded that there are “a lot of problems in the SA healthcare system” but said achieving equity is crucial for everyone to benefit from better healthcare. “We can’t go on as normal and need to have a plan to address the issues…. We need to start somewhere, and need to get more people to contribute constructively to the process.”

Neither Crisp nor Van den Heever went into the exact costs associated with the NHI plan, however various reports have put the potential bill at between R70 billion and R256 billion.

The SA government’s healthcare budget currently sits at more than R200 billion annually, but Finance Minister Tito Mboweni revealed in his Medium-Term Budget Policy Statement speech in October that the rollout of the NHI will require an additional R33 billion annually from 2025/26.

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This will be South Afica’s biggest Ponzi Scheme, bigger than the Corrupt Eskom, SAA, PRASA, etc. all rolled into one.

Anybody happy with dental and health care? The service is pathetic. Any professionals out there any more?

It is an attempt by the government to take over a huge portion of the country’s GDP. There will be all the usual graft and thievery to follow.

The government is merely a tool in the hands of Luthuli House. Luthuli House, in turn, is a tool in the hands of the average voter. The average voter is a communalist with socialist tendencies who receives more from the state than what he contributes to the state. It is to be expected, therefore, that this group will use their legislative powers to get benefits that they cannot afford to pay for. This is the majority who makes the laws that determine our future.

Because this process is so logical, the results are also highly predictable. The results are not logical or beneficial, on the contrary, it is destructive and crazy, but the implementation of failed strategies are unavoidable. The quality of the infrastructure and the efficiency of service delivery can never be more than the manifestation of the mindset of the average voter.

This unstoppable force will continue until the sophisticated healthcare facility resembles the rooms of the traditional healer in the rural areas. It works the other way around in individualist societies. Attitude is everything. Never underestimate the powerful forces by which the mindset shapes its own realities.

Socialism only works – and then often not very well – in countries where a very large percentage of the population (e.g.60% +) actually pay income tax. Here in SA, Socialism cannot, cannot, cannot work. Out of a population of 57 million (all of whom want free healthcare), only about 4 million people pay 95% of all taxes. NB!!! ALL TAXES – INCOME, VAT, CORPORATE, CGT AND THE HUNDRED OTHER ANC STEALTH TAXES. Logic tells me that 4 million could live very well off 57 million, but 57 million absolutely cannot live off 4 million – especially when their birthrates are well in excess of European standards. So the NHI is doomed from the start. QED.

Has the ANC ever come up with a good plan that they could manage properly?

Would this NHI “plan” give the deployed cadres opportunity for corruption?

Can the ANC manage corruption or is the ANC itself rotten to the core with corruption?

The way I see it, NHI is State Capture by Big (Health) Business.

The cannot even get their local hospitals – which are there to provide all the free care at present – to work properly- This will be blatant theft and socialist horses manure !!!

“Crisp conceded that there are “a lot of problems in the SA healthcare system” but said achieving equity is crucial for everyone to benefit from better healthcare.”
Let us attempt to decipher this Newspeak from Dr Nicholas Crisp, an advisor to the Department of Health on the NHI, for a moment:
1. We have strawberries (in the form of private healthcare), but they do need a bit of sugar.
2. Then we have the contents of the longdrop (in the form of public healthcare), that needs serious treatment.
3. Let’s mix the strawberries and the contents of the longdrop to create a dish that is suitable for all.
4. Oh, and by the way, this new dish will cost more than the original strawberries.
5. Voila, we have created a super-duper product – the NHI.

Produce more doctors to reduce the cost gap first. Regulate medicine and medical procedure costs and get public health care right for what exists.

@Africa Pragmatist

I would say producing more doctors is easy, I mean we have Dr Mbuyiseni Ndlozi.

Medical doctors, that have studied and passed the necessary exams, getting more of them, that’s a different story.

I would suggest the education system is looked at, it starts from grass roots. Even if this is fixed, it would arguably take around 15-20 years to see the fruits of this change.

But that won’t matter if NHI is implemented. A number of survey’s have indicated that anywhere from 40% plus of private health professionals will look to leave South Africa if NHI is implemented.

I would argue, the only acceptable plan would be to stop NHI in it’s entirety.

NHI is just another vehicle designed by the corrupt ANC government to plunder, like the Road Accident fund and all the others. The cannot manage the provincial hospitals to function properly. All these hospitals (in fact ALL the SOS’s) were functioning 100% under the previous government, today the are all mismanaged, plundered and bankrupt. Thank you ANC!!!!

Governments wants gets its paws into Medical Aid companies risk reserves . This is one of the true motivating
factors behind the pursuit of NHI . Reserves currently stand at R70 billion . Imagine how many luxury cars you
buy with this money …….party party party !

Nail on the head there. All in line with the original theme. RDP – Rape, Pillage & Destroy. To date that has been pretty successful. Private pensions are also well within the target of that plan.

Yes that is rather obvious and it will go the same ay as all other state owned organizations into the toilet and place the country into a deeper hole than it already and s, don’t we learn?

That’s the aim of the communist anc…central control of everything even though their 25 year tack record should tell them that, as with other similarly failed socialist experiments, they don’t have a clue and it will fail like Cuba, Venezuela etc.

None so blind who just won’t see !

“Even for people who have medical aid, there are challenges.… You have to ask: are they happy to have medical aid increases of 11% this year? They are not even getting salary increases at that level, so are also facing higher healthcare costs,”

In reality these people still pay for most services. The monthly contributions are generally there to have insurance for hospitalization. Under NHI they will pay much more than 11% because the availability of skilled help will be capped due to emigration of young professionals.

What stuns me is that this government actually cannot see its own track record of incompetence and now wants NHI. Surely show taxpayers that you can fix an Eskom, SARS, SAPS, SAA and then think about NHI? Its dreadful that despite our colossal tax bills(VAT, petrol, Customs, Individual at 45% for just on USD 100k) that health services do not function but this is due to incompetence and the national sport of the ANC ie Theft and corruption!

Little is worse than knowing that you do not know!

Acknowledging their shortcomings would require honesty and honesty is in short supply in the ANC.

What track record of imcompetence ??? They have actually been extremely competent is their policy implementation , which is pure plunder and Pillage ! Not one in Jail and the plunder continues , so the perfect plan as far as I can tell !

Complaining does not help. How do we stop this rubbish???

To the ANC Government:
1. Get the Govt hospitals up to a level which provides a viable alternative to those who don’t want or cannot afford private medical aid. This way you will draw people into the system instead of breaking something that already works.
2. Do you realize the massive unintended consequences of forcing NHI on taxpayers. Those who were thinking of leaving will do so in their droves, leaving even less tax money to fund this socialistic pipe dream.
3. Do your figures correctly and show people honestly how much this is going to cost. If people knew the reality of the situation, there would be a mass exodus or serious unrest. Be truthful.
4. You are 25 years old now. Grow up and stop destroying everything you touch.
Thank you

Between R70bn and R256bn and counting. Yip. R70bn for actual healthcare and R186bn for the ANC cadres. Their corruption is now so deep-rooted in the fibre of our nation that we may never recover any semblance of good order and trust in those elected to lead . But a time will come when they shall give account andit will be a difficult confession to make. What they have stolen from the country in general and their own, poor voters beggars belief.

If this government has money to spend…then it should be spent on upgrading existing hospitals, training doctors and nurses and educating the general public on modern day lifestyle vices which cause medical conditions needing hospitalization – high blood pressure, heart attacks, liver and kidney disease.
Creating a structure that opens up yet another opportunity to steal more from the taxpayer is just not fair.

More like another monument to corruption and incompetence.

SA is excellent at applying double standards. Monopolies applied by the private sector are illegal and subject to hefty fines – “evil”. Yet monopoly by our socialist/communist government is A, OK. Racial discrimination and racist acts are another “evil” judged by different standards. Hypocrisy rules.

Question: “Have we not learnt from the failures at Eskom and Transnet?”. Answer – No, definitely no. In fact our dear socialist/communist leaders and their sycophant supporters honestly believe there is nothing wrong with state monopolies run by our SOEs. SAA is a recent case in point. We have a better chance at building a snowman in hell than turning this country around. On we plod into the abyss of another failed state wallowing in victimhood.

Like Eskom’s load-shedding, NHI will have “doctor shedding”.

Yup, they’ll shed themselves as soon as they don’t get paid

End of comments.





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