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The future of SA healthcare is uncertain

The pricing model of the NHI makes the future of healthcare sketchy.
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Uncertain. That is what the future of the South African healthcare system looks like following the release of the Health Market Inquiry (HMI) report as well as the National Health Insurance (NHI) Bill, which is under consideration.

“We are moving into very uncertain terrain because we do not know what the details are going to involve when it comes to integrating the private and the public sector,” said independent health economist Haroon Wadee.

Read: NHI benefits and implementation remain undiagnosed

Wadee said this at the Gordon Institute of Business (GIBS), during a panel discussion on the future of the public and private healthcare system in South Africa.

Pricing and access to quality healthcare dominated the discussion.


“We can’t talk access when the pricing of services is out of range. Even when access is there, it is available in minimal terms, and that speaks to quality,” said Dr Ntuthuko Bhengu, HMI panellist and health sector specialist.

Section 27 Executive Director Umunyana Rugege said that the fact that doctors can’t negotiate pricing is one of the reasons that pricing will be a challenge in the future.

“I think it is time now that we think of how parties could get into a room and share information and begin to set prices,” she said.

Dis-empowered and incomplete regulation

Rugege also raised concerns on how patients and healthcare users are disempowered. She said they lack information and understanding and currently there is nowhere to go for them to acquire the relevant information and understanding.

“One of the key things that we understood was that there was incomplete and inadequate regulation in the sector.

Rugege recommends a concentrated effort that investigates the private healthcare system.

“Even though it was never our call to regulate the sector, we believe that even in a private sector and market, the state had primary obligations in terms of Section 27 of our Constitution, to enable and to enhance the right to the healthcare system.”

She says the other fundamental issue is to address transformation and inequality – even in a profits-driven market such as private healthcare.

In Section 27’s view the current health system reflects the inequality in the country.

“We have a private healthcare system that serves a very small percentage of 17% to 18% of the population, yet there are not enough resources in the public sector.”

Private sector

Dr Eric Buch, a professor at the University of Pretoria’s School of Health Systems and Public Health, says that based on the HMI it would be in the best interest of the private healthcare system to move rapidly to implement the recommendations.

“I say this because the HMI could become irrelevant if the NHI is implemented in the current visage,” he says, as pricing details are still unclear.

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

“Though there is currently uncertainty on the pricing model, the HMI report helps to lay the foundation in understanding pricing and the reimbursement models. There is a need to be reflective from the public sector side as well as from the private sector side,” says Buch.

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The PRIVATE healthcare sector is a BUSINESS. It has been created because the PUBLIC healthcare sector is terrible. Government takes BILLIONS in public money every year for healthcare and does what with it, exactly? The answer to SA’s healthcare problems is not to drag private healthcare down to the level of public healthcare, its to get rid of the utterly useless ANC and put a competent party in charge who can fix public healthcare with the money they already have by employing honest, efficient public servants who will do their jobs and expand on the training programmes we have.

I’d be wasting my time trying to better this comment. WELL SAID, SIR!

We have an applicable example of the future of healthcare. The future for healthcare, therefore, is not uncertain but rather relatively predictable. The NHI is for the healthcare sector what the Mining Charter is for the mining sector. We are blessed with an abundance of mineral wealth but we are unable to extract it. The Mining Charter enables the zamma-zamma industry, while it increases unemployment. Mining companies avoid South Africa and go elsewhere.

Apply this situation to the healthcare industry and the following becomes clear: We will have the most patients in dire need of medical care in the world, but no doctors. The NHI will incentivise the “informal” medical practitioners and backstreet surgeries will flourish. Qualified nursing staff will become unemployed. Luthuli House will become a morgue, in honour of the NHI. Patients with money will avoid the NHI to explore opportunities offshore.

You see, under socialism, the future becomes boringly predictable.

The Government made sure that those that can’t afford healthcare don’t get it. They destroyed the public healthcare system.
Now, if you can pay for it you get it.
Survival of the fittest?

Any answer to SA’s problems that involves getting rid of the ANC is pie in the sky. I think many South Africans don’t, or refuse to, understand the tribal nature of SA politics. They look for saviors, like the president, which are essentially the same corrupt lot as the ANC.

(Before I get attacked on this comment, think how it is possible to go from having nothing to becoming a billionaire in a communist state in only a decade or so. Hard work? Yeah right…)

Even if the country burns to ashes around them, the electorate will still vote for ANC.

Only realistic solution is to leave the country.

The first citizen amassed his wealth by using his position of power to change the law to enable the expropriation of property. They wrapped this process in cotton and called it restitution while in fact, it is retribution. Now, everyone abuses their position of power to expropriate the property of others. For most people, this position of power is the fact that he is able to carry a box of matches and a tyre. Then he uses this power to get a house for free, electricity and water for free, education for free and food for free. All that stuff that he gets for free, was the property of someone else and was paid for by someone else. They use the legal framework to extort the property of others. They simply follow the example that was set by the first citizen.


Nope, you won’t get attacked for your comment. Instead you’ll get supported! (the reality is what it is)

Talking about “leaving” the country. Mad Bob Mugabe LEFT the country (albeit temporarily) each time he went to visit Singapore for 1st world healthcare.

There are, in my opinion, 3 reasons for their lack of understanding.
1. They are mentally ill, they have a Stockholm syndrome type relationship with the country. I see this in many of my friends and colleagues of all races. Kind of like the jews who stayed knowing they were doomed.
2. The are in a bubble, when last were you in a township, took a public taxi, or needed to use a public clinic.How many of the 99 percent to they even mingle with.
3. They know they are prisoners and can do nothing about it, think #imstaying, more like #gotnochoice. No other passport, over 35, middle class and not a scarce skill, and teaching in China aint for you, SA is your home gotta make peace.

Well well, the following eventually could happen:

Many private hospitals (and practitioners alike) may go rogue, as offers there services “cash” in a “supply vs demand” approach…..exactly like you go and spend on a pricey tablet, car finance, etc.

Govt will likely withdraw certain healthcare practitioners’ practice licences that chose to go rogue….but guess what, the public (in need of real care) WILL also go rogue.

If say my own GP & specialist(s) that I knew for years, end up practicing rogue with their licence suddenly revoked…but it doesn’t nullify that healthcare practitioner’s astute knowledge…..I’d STILL go to him/her (as the care will still be better, as opposed to be left tangled up in Govt bureaucracy, and told who they think you should see! )

Yes, it will operate almost like the ‘zama zamas’.

We all tend to complain about current cost of medical scheme premiums & treatment. Let’s allow the healthcare industry to go rogue, and them set daily/moving prices based on supply vs demand on a particular minute….like the airline’s pricing model. Like Uber. You book your treatment via phone app, etc. Then one will see what the true cost of medical care is, and based on a fair model. Doctors could earn more, attracting more doctors to SA, bringing down price (..i know…there’s a myriad of regulation, morals, to overcome….but think about it)

The above is what could happen(?)

Just imagine Govt interferes to such an extent in your daily life, telling to where to buy your groceries on any particular day.

The law of unintended consequences. The private sector health workers will just leave. Health workers are in demand across the globe.
Parking the funding of NHI aside. How will the powers to be manage something that conservatively 5 times larger than Eskom ?
Watch Chernobyl series for the answer. As Legaslov said: ” Every lie incurs a debt to the truth and one day the truth has to be paid”

Also from Chernobyl we saw: A shoe salesman overriding a nuclear physicist. Only our politicians are less qualified. Too old to start a practice elsewhere, but thankfully old enough and comfortable enough to retire, albeit 10 years earlier than thought. And with enough offshore money to buy healthcare elsewhere. The NHI will be the final event in our death spire.

Actually, with the ANC in charge and based on 25 year’s of evidence the future of healthcare is quite certain: It will be a massive cock-up.

You can forget health care. I am in theatre at a Cape Town hospital needing blood and special equipment for my patient. All roads in Cape Town have been blocked by taxis.
The writing is on the wall. Get your glasses and read it carefully.

The tendentious and insidious language of the HMI passes almost unnoticed in the torrent of clichés. Such as

‘the other fundamental issue is to address transformation and inequality – even in a profits-driven market’

and all this talk of a ‘private healthcare system’, as though there were a sort of parallel state which is misappropriating the available resources.

By the same logic we should be addressing the ‘private transport system’ since a lot of people can’t afford cars. Or the ‘private alimentation and catering system’ – as many people can’t afford to eat in restaurants we will close them and have everyone report to a public feeding facility at times to be determined by regulation (though times will be synchronised with the load-shedding schedule so that we can all enjoy the candlelit atmosphere).

If Government cannot provide decent public healthcare then no one should have decent healthcare. That’s how the ANC equalises things plus they know their ‘sheep’ will comply.

End of comments.





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