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                                             its bulk purchasing power to reduce   have more money available via new
                                     12      costs. Belief that a monopoly will   NHI taxes. Yet, as we noted above,
                                             be a more efficient purchaser       the public sector expenditure has
        grown substantially over the past    and more cost-effective than a      doubled when measured in real
        two decades. Measured in real and    competitive free market system      and per capita terms over the past
        per capita terms, the 2021 public    again amply illustrates the socialist   two decades. If the government’s
        health budget is double what it was   underpinnings of this proposal. The   only obstacle to achieving a
        in 2000. In our research paper, we   current public health system is also   world-class healthcare system
        undertook a review of public health   a monopoly. Public sector patients   was money, why is the current
        expenditure among two dozen          have no alternatives and there are   public health system not a sterling
        developing economies with per        no competing forces within public   example of what it claims it is
        capita GDPs that were higher than    sector provision of healthcare. If   capable of achieving?
        that of SA. By comparison, SA’s per   anyone requires evidence of how
        capita public health spend lay within   healthcare monopolies perform,   Government would have us believe
        the second highest quartile of these   they need look no further than    – without any clarifying analysis
        24 wealthier countries, indicating   our existing public health sector.   or supporting research – that if
        that the SA government spends        Quality is poor, outcomes lag       taxpayers pay additional taxes to
        more on public healthcare than most   behind our peers, shortages        finance NHI, and the government
        of its richer peers. Yet, when we    and wastage are commonplace,        nationalises the private sector,
        undertook a comparative analysis     corruption is rife, and the medical   magically, there will be world-class
        of the public health outcomes within   malpractice liability now exceeds   healthcare available for every
        the same countries, SA ranks         R120bn, equal to about half the     citizen in the land. Crisp rejects the
        almost at the bottom.                national public health budget.      notion that NHI is unaffordable, yet,
                                                                                 the NHI green paper and both white
        Crisp also trots out the moribund    In a nutshell, what the NHI is      papers outlined various funding
        policy argument that because the     proposing is to nationalise the     options to raise an additional 3%
        NHI Fund will be a monopoly, akin    private sector and integrate it into   of GDP in NHI taxes, a staggering
        to one giant medical scheme for      the public sector. On this basis,   R165bn which, when added to the
        the country, it will be cheaper and   government believes it will fix its   current public health budget and
        simpler to administer, and it can use   healthcare system because it will   other smaller funding sources,
                                                                                 provides the NHI Fund with a
                                                                                 budget exceeding R450bn annually
                                                                                 in current values.

                                                                                 The overarching problem with this
                                                                                 NHI proposal is its poor governance
                                                                                 framework. The NHI Bill bestows
                                                                                 far-reaching and autocratic powers
                                                                                 upon the Minister of Health, who
                                                                                 will have singular control over all
                                                                                 senior appointments within the
                                                                                 NHI; the members of the various
                                                                                 NHI sub-committees that will
                                                                                 control accreditation of providers;
                                                                                 what levels of reimbursement they
                                                                                 will receive; and the centralised
                                                                                 procurement of products and
                                                                                 services amounting to hundreds of
                                                                                 billions of rands annually.

                                                                                 Crisp’s assertion that
                                                                                 “unprecedented safeguards” have
                                                                                 been put in place against corruption
                                                                                 simply holds no muster when read
                                                                                 against the extensive authoritarian
                                                                                 powers that the NHI Bill will confer
                                                                                 on the Minister of Health.

                                                                                 This article was first published on
                                                                                 BizNews on 22 November 2021.

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