Fiscal crunch means NHI projects on back-burner — Motsoaledi

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National Health Insurance (NHI) projects will be put on the back-burner as the Health Department has to reprioritise its budget, Health Minister Aaron Motsoaledi said. Fin24 reports that speaking at a University of Stellenbosch Business School event he said that Treasury had essentially cut back allocations to the Health Department by R9bn since 2015, while State subsidies and medical tax credits for private healthcare users grew by R11bn.

Given the reduced budget allocations, the Health Department had to “go back to the drawing board” to decide which treatments to prioritise, he explained. Having spoken to former finance minister Nhlanhla Nene and Treasury director general Dondo Mogajane about the need to improve staff recruitment, it was decided the Health Department would re-prioritise monies intended for NHI to recruit over 2000 healthcare professionals and purchase beds and linen for hospitals in dire need.

The report says the plan to recruit more healthcare workers and buy linen is part of reforms included in the economic stimulus package.

During follow-up questions by journalists about whether Treasury had been protecting the Health Department, Motsoaledi said this had not been the case. “I can assure you, there was no protection for health,” he said. Budget cuts have affected health care infrastructure and human resources, he explained. When asked if he was happy about the changes which have come about because of the economic stimulus package, Motsoaledi said he is not and that he has no option.

Part of the money given for NHI is now going towards the objectives of the stimulus package – the report says Motsoaledi described it as government taking away from the same hand they had given to. “It is not new money. I would have been happy if it was new money for the stimulus, but it is money which was given for NHI projects, and then you have to delay them, unfortunately.”

Motsoaledi said that the country is better off if the Health Department keeps existing services going, as opposed to taking them away in favour of introducing new services in line with NHI. According to the report, he said that he held back on spending the R4.1bn NHI money, because he was warned as early as May that re-prioritsation would be on the cards. “If we rushed and used the money for new things, and then all of a sudden we have lost all the old service delivery that was there – it would have been a crisis for the country.”

Motsoaledi said government is not trying to solicit votes through the implementation of the NHI, reports Polity. He said that, in his experience of attending the World Health Assembly – an annual gathering of global health ministers in Geneva, Switzerland, none of the countries present had used universal health coverage as an “election ticket”. The minister added that, in his opinion, 90% of South Africa’s healthcare system is designed for “well-to-do” people, and not poor people.

No medical textbooks would prescribe different treatments for diseases like cancer based on the socio-economic status of a patient, said the minister. The report says speaking of the world’s first heart transplant performed by Dr Chris Barnard in 1967 in Cape Town, Motsoaledi said that economic status of the patient Louis Washkansky’s did not determine whether he could get a heart or not. “All he (Washkansky) knew was that he is sick and he knew he needed a new heart. It was not a question of whether he had medical aid, his bank balance or if he had a farm to mortgage.” It was simply a question of his health, which no one debated, said Motsoaledi.

Today, however, socio-economic status determines the quality of healthcare people have access to, he said. In addition, he said that people have been conditioned to believe that quality healthcare must be expensive. One of the findings of the Health Market Inquiry’s report, released earlier this year, is that there is “something wrong” with the cost of private healthcare in SA, said the minister. “People associate good healthcare to exorbitant pricing. That is unrealistic,” he said. And while there is mismanagement and corruption in the healthcare system, he argued that these problems are secondary to the primary problem of inequality.

The report says the minister supported his argument around healthcare inequality by noting that South Africa spends 8.7% of GDP on health. Of this, he said private sector spends 4.5% of the country’s GDP to provide care for 16% of the population, while the public sector spends 4.2% to provide healthcare for 84% of the population. People believe that by “some miracle” without corruption and mismanagement the state can provide quality healthcare for 86% of the population on 4.2% of GDP, when 16% of the population receives healthcare on 4.5% of GDP, he said. “This is gross inequality.”

Motsoaledi also said that, between 2015 and 2018, state subsidies and medical tax credits provided by the SA Revenue Service to private healthcare users grew by R11bn from R46.8bn to R57bn. Meanwhile, Treasury had made cuts of R9bn to the public health sector given the economic downturn, he said.

The report says Motsoaledi ended his address by saying that NHI could not be costed. On the question of affordability, the minister rather asked if the country could afford not to provide healthcare. He said that, in 1996, if HIV treatment had to be priced, it would have not rolled out. “It would have been billions that scare you.”

Fin24 report
Polity report


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