Western Cape Will Participate in National Health Insurance Pilot

Western Cape Health Minister Theuns Botha says that although the Western Cape does not support the National Health Insurance (NHI) green paper in its current format, it does not mean that the province will not participate in the NHI pilot projects.

"There is a rumour doing the rounds that the Western Cape has declined to participate in the NHI pilot. This is not true. My office has not received any correspondence from the national minister's office in this regard, and has certainly not declined to participate."

Research in the Western Cape shows that the NHI will work against its stated objective to provide improved quality health services. In fact, it appears the NHI will create a bureaucratic and inefficient healthcare superstructure that will diminish the quality of public healthcare.

Western Cape Government did extensive research and consulted with economists and professionals before we submitted a comprehensive reply to the NHI green paper. In our reply, we point out the following reasons why the NHI will not improve the quality of healthcare to the poor.

1. NHI does not fix the real problem of low-quality healthcare provision in the public sector.
2. NHI does not adequately attend to accountability and management structures. While the green paper calls for an Office of Standards Compliance - which we support in principle - but its members will be appointed by, and answer to, the health minister. It will not be independent, making it vulnerable to political influence and manipulation.
3. We lack the human resources to implement NHI which demands that we triple the 27 000 doctors that we currently have. But we only train enough doctors each year to keep pace with the numbers who retire or emigrate. The state is unable to train the necessary number of doctors to implement NHI.
4. The creation of a centralised fund will over-bureaucratise the public healthcare system rendering it more inefficient and costly than it is currently. The size and scope of our department will be reduced to that of a branch office of the national department.
5. Throwing money at a problem does not always solve it. South Africa spends R2 766 on public healthcare per person each year - far more than other developing countries.

As an alternative solution, Western Cape Government proposes Universal Healthcare, built on a primary healthcare basis, similar to the structures implemented in the Western Cape at present, where patients are referred to regional and specialised facilities according to their medical needs, and government providing the transport infrastructure. The rest is governance-based on good business principles - financial discipline, efficiency, equality, modernisation, monitoring and evaluation.

"In the Western Cape, we offer a model of healthcare provision that leverages our system's strengths, minimises its deficiencies and delivers good health services in a responsible and sustainable manner. And we do not blame the private sector for any difficulties we face; rather, we seek out public-private partnerships so that we can both participate in the improvement of the province's total health service effort. At the heart of our provincial system is a commitment to accountability, affordability and efficiency - all necessary elements for high-quality health outcomes.

"The lesson we have learned in the Western Cape is that we can improve healthcare for everyone by strengthening the positive elements of the public sector and removing its deficiencies on a planned and sustained basis. Our policies in the Western Cape are working to achieve this at a provincial level. There is no reason why these strategies can't work for the rest of the country as well," said Minister Botha.