Ramaphosa signed NHI into law last week in a blatant election move. Immediately he and ANC said, in response to criticism and concerns, it would be incremental and could be changed.
People prefer paying extortionate private healthcare fees rather than resist. But the problem is that in a supposed free market people are held to ransom by healthcare providers and don't have a choice. NHI will make things far, far worse, and the ANC will mess things up and steal as they always do (assuming they're still in power if and when it begins).
But private healthcare (PH) partly has themselves to blame for this situation. And they've brought the problem down on all of us with heavy handed state intervention.
NHI started with complaints of the costs of PH and that it was exclusionary - it absorbed a huge chunk of national health expenditure for a small percentage of the population. Statements now by NHI critics that SA's out-of-pocket health costs are among the lowest - 12th lowest - in the world per capita (in USD) is disingenuous because it doesn't reflect individuals' actual expenditure. And it's an aggregate figure of the entire population most of whom get free, or mostly free, public health. (Remove the public component and see what the out-of-pocket costs are.)
Private clinics and doctors charge what they like. Unlike other private sectors, there's little choice - all doctors effectively belong to the same organisation - and few clinic groups. For example, how can a surgeon charge, say, R40 000 for a two-hour procedure.
There's brouhaha, and rightly so, about NHI but only murmurs about PH costs, with no sustained activism including by media that those limitless costs must be contained. Since NHI was first mooted, the only story is the doom for healthcare. And now it's here, and years of controversy as the fight goes to court.
BTW Western Cape's public health still works, just. It has problems, though - don't let hubristic and know-all DA tell you otherwise. I'm a user and have had a 50/50 experience. It could be better within its resources and pressures.
One problem WC, like SA state health, has is the amount of medical negligence claims. It's not legal touting as both claim but a real problem. Simplifying greatly, it's an overall lower level of care one would seldom find in PH. It's avoidable, often the lack of supervision and standard medical procedures. (Groote Schuur's operations manager, Dr Belinda Jacob, told me in 2022 they - WCHD - have "no control over heads of departments' decision-making" (sic), and by extension, their subordinates. Really. Their universal cop-out.)
Two years ago I had a surprisingly good experience at Groote Schuur. Minor surgery. In theatre an all-woman team - surgeon and assistant, nurse, medical student and three anaesthetists - consultant and two registrars. They also called a senior anaesthetist in for a consult. Three nights, everything included, my bill: R320 - not a typo. (It should've been free but who's complaining.)
My concern was the absence of uniform care - too many cooks; they had a lot of people (doctors) walking around, distracted, paying little attention to what patients were saying about their conditions. A common occurrence.
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