Neither of South Africa’s two parallel health systems, public and private, functions well, says Dr Nicholas Crisp, deputy director-general in the Health Department, although “one looks prettier than the other”.
“We are on a hiding to nowhere with these current systems,” he told the Sunday Times, adding that the National Health Insurance (NHI), still under construction, “is a massive multi-year reform programme going forward”.
SA spends 8.5% of its GDP on health and “given the size of this resource”, it is even worse that the two health systems, divided along socioeconomic lines, are not as functional and free of theft as they should be.
Crisp said if one considered that SA has the 35th-biggest economy in the world, “we perform very badly on health outcomes”.
The health system was “hugely fragmented”, he added, and in the case of the public system, that was because of nine provinces managing their own departments.
In the private sector “it’s even more complicated as there are 76 schemes and the complexity of the administration makes it very expensive to run.”
A crucial part of the NHI is the digital system backing it up, which is being built, said Crisp, and it’s all about the patient.
“Everyone needs one portable health record that follows you for life. That becomes your file number…a digital record in cyberspace with tight security and data that belongs to the patient.
“In Japan it took 34 years, but 34 years is a journey starting on day one. We are putting digital systems in place. Our data centre is already in place, as is our coding system.”
Experts agree the existing system is a mess.
Mande Toubkin, a general manager at Netcare, said: “We do not need political antagonism. We need a functional health system that works for everyone.”
Human rights activist Mark Heywood added: “The biggest problem is governance and management … we spend 8.5% of our GDP on health, but allocation and theft are a problem. The mess gets worse and is costing lives.”
Cas Coovadia, head of Business Unity SA, said: “We need to collaborate on the whole NHI debate and have a common focus, as we did with COVID.
“The NHI focus has to be on universal healthcare… Let’s not break what’s working. The private system is working and should not be put at risk.”
“I have family who can’t meet my eye,” Crisp laughed, “because they think I am a crazy communist. You also get the people in Diepsloot who’ll be the first to realise they don’t have to go all the way to Charlotte Maxeke when there is a hospital much nearer which they can’t use under the current system.
“Then you’ll get the lady in Dainfern who can’t handle that she may end up in the same ward as her gardener from Diepsloot.”
See more from MedicalBrief archives:
Crisp: We’re not going to backtrack on implementation of NHI
Crisp says Health budget has to be bigger if NHI goals are to become a reality
Crisp: Payroll tax, surcharges on personal income tax to fund NHI