The world is an unequal place demonstrated clearly by the fact that the 62 richest people in the world are as wealthy as the remaining 7 billion. As the number of people on the planet grows, and the amount of resources remains the same, it seems inevitable that the divide between rich and poor will continue to worsen.

In South Africa, as around the world, a person’s wealth can significantly impact their health. The Right to Health is enshrined in the Constitution and as of 2015 around six percent of the annual budget was spent on healthcare for the population. However, the quality of healthcare that ordinary South Africans receive is largely controlled by their income.

A two-tier system exists, with the small private medical sector servicing the wealthy and the large public sector health system servicing around 80% of the population. Almost 40% of South Africans are unemployed, and few employers provide medical aid as an employment benefit. Thus, the majority of the population has no choice but to utilize public health care, with services of varying quality and sometimes criminal negligence.

In addition, the cost of health care means that in some instances even those with medical aid cannot afford it. Treatment for serious illnesses such as cancer can involve bills in the millions of Rand meaning many people must weigh up their financial security against their health.

The National Health Insurance, currently being piloted at eleven sites around the country, aims to provide universal healthcare to South Africans at an affordable rate. Rather than aiming to get rid of the private system, it aims to provide the same level of care at a much broader range of sites.

A challenge that it continues to face is the willingness of doctors and specialists to come on board. The private sector is not only attractive to the population in terms of its level of care, but also attractive to medical professionals. Often private health care is situated in a more central and accessible area, and doctors can receive better salaries it these facilities. Thus, a significant number of the specialist doctors are located within the private sector, and do not want to move into the public sector. This affects the ability of the NHI programme to succeed.

The pressure on the healthcare system is significant, so where to from here? Over the next decade, financial commitment from the Government to strengthen the ability of the NHI to attract good doctors is required in order to ensure that medicines and treatments are affordable for both the rich and poor. In the meantime, finances should be directed towards ensuring that all health care facilities in South Africa provide a good quality of care.

Sources:

• Oxfam (2016) http://www.theguardian.com/business/2016/jan/18/richest-62-billionaires-wealthy-half-world-population-combined
• National Treasury (2015) Estimates of National Expenditure 2015. Pretoria, National Treasury.
• Kahn, T (2015) “Lack of private GP buy-in is the Achilles heel of NHI.” http://www.bdlive.co.za/opinion/2015/03/26/lack-of-private-gp-buy-in-is-the-achilles-heel-of-nhi
• Pitjeng, R (2015) “Health Dept: Quality healthcare becoming unaffordable.” http://ewn.co.za/2015/12/12/Health-Dept-Quality-health-care-becoming-unaffordable
• Gqirana, T (2015) “NHI to reduce the cost of healthcare” http://mg.co.za/article/2015-08-22-nhi-to-reduce-cost-of-healthcare