NHI setback shows healthcare reform cannot be imposed by force

Once again, the courts have stepped in to rein in government hubris and overreach – but the Constitutional Court’s decision that the new National Health Insurance (NHI) is unconstitutional when it comes to stipulating where medical professionals may, or may not, work is a ruling with far-reaching implications.

The right of the department of health to, effectively, accelerate the dismantling of private health services by unilaterally making doctors and others subject to the dictates of the state was going to be one of the key pillars of the NHI.

It was also the one which attracted some of the strongest criticism of the proposal for a national health service, as well as being one of the main motivating reasons for health professionals to be looking abroad for work.

That latter impact was entirely foreseeable given the fact that the state health services – despite massive funding – are often in a state of near-collapse.

Health workers in the private sector were concerned that they would be dragged into the ongoing dysfunction.

That is not to say there aren’t dedicated people within the state health sector, or that the country doesn’t need a more equitable system of healthcare.

Private medical attention costs the literal arm and a leg, and even those with medical aid find themselves in financial stress when having to make co-payments.

There are a number of reasons the state health service is functioning well below optimal levels.

First, even though plenty of money is thrown at it, huge proportions of that money are not used properly, or they don’t even get used at all, because they are looted at the source.

One only has to look at the Thembisa hospital corruption, in which the thick end of R2 billion in state money never got where it was intended, to see evidence of this.

Not only that, medical expenditure has proved to be a particularly deep trough for the ANC’s apparatchiks – and it is they who are largely responsible – to gorge themselves.

Undoubtedly, too, the mass influx of economic migrants – who flock to South Africa because our immigration controls are almost non-existent – is putting immense pressure on health services in South Africa, which are still obliged to treat patients no matter where they come from, or whether they are here illegally.

The Constitutional Court ruling basically entrenches the rights of both medical professionals and medical-related businesses to earn their money in whichever way they choose.

It means that the private medical sector – which, at its best, is world-class – is here to stay.

What needs to be done now is to start from scratch and iron out a public-private partnership which would spread free or affordable care across a wider spectrum.

Such a system cannot – as the Constitutional Court has said – in reality be imposed by diktat from above in an attempt to establish some form of socialist paradise.

Nor can it, or should it, be forced upon a dwindling group of taxpayers through increased taxes or targeted levies.

Eliminating corruption would be a major step towards improving efficiency in the entire government sector – and any attempt at that should begin in the medical sector.

Stop the bleeding there, and the patient can have a good chance of survival.