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If the government cannot run public hospitals how can it possibly run an NHI? - Dr. Serfontein

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Published on May 20, 2016

Dr. Johann Serfontein

In 2013, the government published a report on a Baseline Audit for Government Health Facilities. 3880 facilities were audited during this process. Of these, only 32 complied with infection control guidelines and only a quarter of clinic staff had a positive and caring attitude.

93% of maternity facilities did not have the necessary equipment to ensure mother and baby treatment safety and only 2 facilities could guarantee general patient safety. This is a grim picture, indeed.

The 2014/15 National Inspections of 417 facilities by the Office of Healthcare Standards Compliance showed that only 3.1% of facilities were considered compliant. Another 13% of facilities were conditionally compliant. 67.6% of the inspected facilities were Non-Compliant or Critically Non-Compliant.

In the NHI white paper it is stated that “Health facilities that meet nationally approved standards will be certified by the Office of Health Standards Compliance to render health services”. If this office performed its mandate with these inspection results, only 16% of public health facilities would currently be operational in the NHI.




At the unveiling of the White Paper, the Minister of Health once again indicated that 80% of specialists are serving 16% of the population in the private sector and that this inequitable distribution is unacceptable and will be changed by the proposed NHI.

Actual research figures published by Econex in 2013, which was also used in the Department of Health’s own Human Resources for Health publication, shows that between 28% and 38% of residents in South Africa utilise private healthcare.

41% of specialists work in the public sector, with 59% working in the private sector. The data in the NHI policy papers which is used to try and justify radical changes to the Healthcare system in South Africa is thus incorrect.

The NHI is actually a funding model and is like a huge medical scheme. Imagine a Medical scheme with about 25 times as many members as Discovery Health. Government’s administrative incompetence, is clearly demonstrated by the Compensation Fund.

This fund receives about 8 billion a year in income and currently has R52 billion in assets, most of which is administered by the Public Investment Corporation (PIC). Between 2012 and 2015 the fund paid out claims of between R1.4 billion and R2.1 billion annually.

In April 2015, in answer to a parliamentary question, the Director General reported that there were 231 000 outstanding claims, amounting to R23 billion. They planned to have the backlog cleared before June 2015.

So in 2 months, they planned to pay more claims than in the past 10-12 years, and to distribute half the Fund’s total assets in those 2 months. The Compensation Fund employs 1630 people who paid out 1.4 billion Rand in medical claims last year.

By comparison, Discovery Health, which has 5 times the number of employees, paid out 26 times the amount in medical claims.

The NHI budget is 32 times larger than that of the Compensation Fund and total claims payable are likely to be 100 times more, not including paying suppliers. The NHI Fund would therefore have to employ between 52 000 and 160 000 people. If the Government is unable to run an R8 billion fund efficiently, how will it possibly manage a R256 billion fund?




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