Covid-19 reveals NHI plan’s vulnerabilities and strengths

The final outcome of the Covid-19 crisis will decide if the planned National Health Insurance (NHI) project lives or dies – but experts are divided on which way it turns out.

The Covid-19 crisis has seen the public and private sectors hit by massive changes in demand for certain services, unmasking vulnerabilities which, according to Professor Alex van den Heever, could see the nationalisation of the health system die as a mere dream.

Van den Heever, chair of social security systems administration and management studies at Wits University, said the lockdown conditions and fear about catching the virus while at healthcare facilities were major factors in the decline in demand for many healthcare services.

“It’s not that people’s needs have necessarily reduced, but many people are really scared to go into a healthcare facility and people have started to hold back getting treatment and consultation,” he said.

“Of course, at the same time there has also been a surge in demand for Covid-19 related services which are very specific services and only parts of the health system have experienced this.

“That includes critical care services such as ICU beds and the resources and staff associated with them. Those nurses now face a big surge and will struggle to meet the demand as the pandemic picks up.

“Already, the public sector in the Western Cape is struggling and will continue to struggle because the virus is really gaining pace in South Africa.”

A recent article penned by the National Health Funders Association suggested that the Covid-19 experience in South Africa not only demonstrated the need for the NHI, but provided important research points to optimise the future of healthcare in the country.

“As the national response to the Covid-19 crisis is showing us, only a rapid and effective removal of the separation between the public and private service delivery systems in South Africa can achieve an optimal nationwide response, not only to this and the inevitable future epidemics, but also pave the way towards universal healthcare in future,” wrote its authors, including Geetesh Solanki, a specialist scientist at the SA Medical Research Council.

The Covid-19 pandemic “provides an opportunity to test or pilot system changes in moving towards UHC”.

Van den Heever said a real-life pilot study may provide a real opportunity to test how a national, unified healthcare platform could work, as it deals with the current epidemic.

“The NHI was not fiscally feasible at the beginning of the year, and now even less so.

“As an institutional reform, it is largely incoherent in my view and there would need to be a lot of reconfiguration to make it workable. Sure, at a political level, you will see it still being suggested that it will go on… but the question is: what counts as political will?”

– simnikiweh@citizen.co.za

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