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Introduction
In South Africa, public and private health systems exist alongside each other. The public
health care system provides services to the majority of the population, but is terribly
underfunded and understaffed. Those who belong in the category of the wealthiest in the
country use the private system and receive much better services. Most of the countries
doctors work in private sector due to the amount of hours they have to work and having to
take home salary-cuts also due to lack of funding. On introducing the National Insurance
Fund (NHIF) and government gearing towards nationalising healthcare in the country, the
way forward seems promising, especially for the poor. The Privatisation of healthcare has its
roots before the apartheid era and usually only serviced those who were wealthy. Since we
are a developing country even though structures of private healthcare exists like medical aid
schemes and hospital plans, citizens who enjoy these benefits pay exorbitant fees.
Considering the majority of the population who are either middle class or are in the low
income bracket, privatising healthcare would just cripple the economy. This essay will firstly
define private and public goods and services. Secondly, it will define nationalisation and
privatisation. Thirdly, it will discuss healthcare reform in South Africa. Fifthly, it will discuss
the nationalisation of healthcare services in South Africa National Health Insurance (NHI).
Sixth, it will discuss those who are in favour of the NHI. Then it will discuss privatisation as
not being an option for the healthcare structure in South Africa. Hence, I will state my
opinion based upon my research found. Lastly, it will conclude and summarise the findings
discussed within the essay.
customer can be excluded from utilizing these goods and services if they cannot afford it or
are not able to pay the seller for it. (Experimental Economics Centre, 2006)
Conversely, Public goods and services are the total opposite, in that everyone can benefit
from the goods and services. There is no excludability, for example, these are goods and
services like traffic lights on our roads which is utilized by all citizens in the country. No
person can be excluded from utilising this service provided for by government as it is
available to all. (Mohr & Seymor, 2012)
Insurance in South Africa, 2011, p. 4) the NHI is intended to bring about reform that will
improve service provision. It will promote equity and efficiency so as to ensure that all South
Africans have access to affordable, quality healthcare services regardless of their socioeconomic status. Therefore, the NHI can be classified as a public good and service, as there
is no exclusion as to whom should enjoy or benefit from this service.
However, the structure of healthcare financing in South Africa varies. Implying that, funding
for healthcare is either provided for through personal cash payments, hospital plans or
medical aid schemes. These financing agreements furnishes private clients with cover.
Healthcare options like these have either been purchased by the client themselves, who
choose the benefit plan and medical-aid scheme of their choice or it has been subsidised by
their employer, and this includes both the private sector and the State. As stated in (National
Health Insurance in South Africa, 2011, p. 4) The other portion is funded through the fiscus
and is mainly for public sector users. Lastly, only clients in the above categories can either
choose a medical-aid scheme or benefit plan of their choice from companies who provide
these services in public sector. The rest of the population who does not fall in these categories
are excluded from these services.
The debates for Nationalising South Africas healthcare dates way back before apartheid,
approximately more than 70 years. This all started in the year 1941, when J. Collie issued the
first health insurance plan in the South African Medical Journal. He was the Chairperson of
the committee of Enquiry into the National Health Insurance. His policy agenda as stated in
(Politics Web, 2009) proposed a health insurance scheme that would cover people of all
races except those who lived in rural areas. The policy plan, at the time, was never carried
out as many came into opposition against the proposal. However, one sees this proposal being
introduced again in the states plan to nationalise healthcare through the NHI. The policy
intends that there be one specific fund for health insurance in South Africa. The fund then is
planned to obtain funds through the common taxes paid and also a type of subsidy from
government for health insurance. The implementation of this policy plan began in the year
2012 and was set to be carried out over a period of 14 years. (Sapa, 2010) Since then, a Plan
of Action was also implemented to help with the implementation of the policy plan.
3
There has been much progress in governments plans to nationalise healthcare. As stated in
the (South African Health Review, 2012/13, p.22) the Department Of Health has had
meetings with medical scheme administrators, labour, the pharmaceutical industry,
professional
associations
for
different
occupations,
statutory
bodies,
government
departments, academia, civil society and parliament. Additionally, there has also been over
one hundred submissions to the National Department of Health and furthermore, in 2011,
specialists from various countries and organisations also conducted an International
conference proposing specific plans for national Health insurance. Lastly, the Minister of
health also conducted road shows which involved provinces where the NHI programme has
been implemented and also met with various stakeholders. All information gathered from
these meetings was to further develop the States goal towards the formation of the White
Paper for National Health Insurance which was released in August 2011. (South African
Health Review, 2012/13)
There have been positive responses from various political parties who were in favour of the
National Health Insurance Policy. In March of 2014, the Treatment Action Campaign (TAC)
released its Peoples Health Manifesto posing a set of eleven questions to political parties
ahead of the elections at the time. There were various questions asked and one of them were,
if they supported the National Insurance Policy. In response to these questions only eight
parties responded to these questions out of the twenty that were asked. Regarding these
questions, the Democratic Alliance (DA), showed support for the policy plan. According to
(Gonzalez, 2014) they stated that DA supports the underlying principle in the National
Health Insurance (NHI) strategy that there must be better cooperation between the public and
private sectors and that partnerships between these two spheres can improve health services
for all. Including, AgangSA who approves the National Health Insurance plan, but grants
that it can only work if we have an efficient government and if specialists in healthcare
operate at all administration levels. Lastly, as stated in (Gonzalez, 2014) that It is
internationally proven that NHI takes between 40 and 60 years to develop and implement in a
country. Therefore many are not in favour of the NHI because the public health framework
4
would need to be upgraded and especially the gap between the rich and the poor before the
country can consider National Health Insurance.
9. Conclusion
5
Finally, Nationalisation of South Africa has begun and it is now up to the various government
departments to carry out the policy plan accordingly. This essay has firstly defined private
and public goods and services. Secondly, it has defined nationalisation and privatisation.
Thirdly, it has discussed healthcare reform in South Africa. Fifthly, it has discussed the
nationalisation of healthcare services in South Africa National Health Insurance (NHI).
Sixth, it has discussed those who are in favour of the NHI. Then, it has discussed
privatisation as not being an option for the healthcare structure in South Africa. To conclude,
I have stated my opinion based upon my research found.