By too rigidly focusing on the NHI Bill, argues Spotlight editor Marcus Low, government risks losing sight of the many other interesting answers to this and other important questions about healthcare reform in South Africa.
Take something as simple as needing medical help when you have flu that just won’t go away. As a private-sector patient, I’d call my GP’s office and make an appointment. Providing I get there on time, chances are I would, at most, be asked to wait for 10 or 20 minutes in a comfortable waiting room.
By contrast, at many public healthcare facilities, you are unable to make an appointment, and often have to wait for long hours in a poorly ventilated and overcrowded waiting area and will probably end up seeing a nurse rather than a GP.
Some aspects of such differences are understandable, albeit deeply problematic. The shortage of doctors is much more acute in the public sector than in the private sector. There is a moral imperative to address this imbalance, but as previously argued, the current NHI plans are just one way to address it.
Why some public healthcare facilities still do not use appointment systems is harder to explain. Even if some users prefer to queue rather than to have appointments, it is odd that all facilities do not at least have hybrid systems with some appointments and some queueing.
Having appointment systems is not rocket science and doesn’t have to cost millions.
There are, of course, other examples. As a private healthcare user, it is relatively trivial for me to get a six-month chronic medication script from my GP and to arrange for the medicines to be delivered to my home.
Though there has been significant progress in this direction in the public sector, many people still find it hard to get scripts and collect their medicines.
Of course, differences in available resources are a large part of what is going on here, but it is not the whole story. As a private healthcare user, my needs, my preferences, and my time are generally respected in a way that seems rare in the public sector.
To be clear, there are many committed healthcare workers in the public sector who show exemplary respect for their patients, but at a systemic level, as in the decision not to have appointment systems or not to allow for extended medicine refills, people’s time and needs are being disregarded.
Apart from the risk of corruption and mismanagement, much of the middle-class resistance to NHI may well have to do with the fear that people who can now access private healthcare services will become subject to precisely this kind of systemic indifference to their needs.
And indeed, while the rhetoric around NHI has often been about ideals like the need for greater social solidarity, we haven’t really seen a vision presented of NHI as offering better, more respectful, and more personalised healthcare.
But with a bit of flexibility, this could change.
Consider annual check-ups. Rather than asking public sector patients to go to overcrowded clinics with long queues for tests, public sector users could be offered the option of basic screening tests for HIV, TB, hypertension, and diabetes done at private pharmacies along the lines of Discovery Health’s Annual Health Check-up.
Of course, data systems will have to be developed to support this and it will have to be budgeted for, but the extra convenience will no doubt make a big difference for many and could help with early detection of these diseases.
Pay up
Getting the state to pay for such check-ups at private sector pharmacies is not exactly NHI as set out in the Bill, but the idea certainly shares some DNA.
In this, as with using public funds to pay for public sector cancer patients to go to private hospitals, there are things we can try that are of the same universe as NHI, but not from the straitjacket of the NHI Bill and all the inflexible thinking surrounding it.
To be fair, there are at least some exceptions that show such innovation is possible. Maybe most notably, these days many state patients can collect their chronic medicines at private pharmacies or other pick-up points.
Though still a work in progress, the evolution of the public sector medicines distribution system shows we need not wait for the NHI Bill before taking steps to make things easier and more convenient for users.
In addition, with the NHI pilot projects we have seen at least some awareness that there is a need to try new things and learn from them.
Unfortunately, on the whole, the NHI pilot projects didn’t meaningfully pilot the key aspects of NHI, and where they did, as with GP contracting, it didn’t go well.
And here one gets to the rub. From the outside there’s the impression that those who wanted to run pilots from which we could actually learn lost out to those who consider the pilots just another step toward building political support for NHI.
As for the NHI Bill itself, that the ANC and much of the Portfolio Committee on Health has been intent on reducing almost all discussion on the Bill to a simple for or against, shows a clear disdain for meaningful engagement.
Indeed, whatever its merits, the ANC’s version of NHI has become fundamentally associated with an overdose of ideology and an absence of curiosity and critical thinking.
But we don’t have to buy into the ANC’s sclerotic thinking. We need not believe the myth that our only choice is between the status quo and the specific future set out in the NHI Bill. Neither do we have to be afraid to ask why the public sector can’t be more like the private sector, or why all clinics can’t have appointment systems.
There are many possible ways to reform and improve our healthcare system. Some will be affordable, some won’t. Either way, it would be foolish to simply turn our backs and pretend they are not there.
See more from MedicalBrief archives:
NHI pilots point to critical fault lines
‘Understaffed’ NHI pilot hospital a publicity stunt, say locals
Parliamentary committee concerns over ‘challenges’ in NHI pilots phase
R5bn wasted on failed NHI pilots could have improved health system — DA