While the National Health Insurance (NHI) pilot sites are being monitored across the country and further implementation plans are being developed, it is still unclear what model the system will ultimately follow.

During a South African Medical Association (SAMA) meeting held at the University of Pretoria, Minister of Health, Dr Aaron Motsoaledi, discussed the progress of NHI and revealed that he has been advised not to follow the American NHI model.

Regarding the progress of preparing SA’s healthcare system for NHI, Dr Motsoaledi said that while “above the water you may see very little, underneath we are paddling furiously.” Dr Motsoaledi explained that some of SA’s medical facilities are only around 30% viable in terms of medical equipment and physical infrastructure, and it’s therefore essential to build physical and human resource capacity.

Dr Motsoaledi revealed that he regularly attends an annual function at Harvard Medical School, where professors have urged SA not to follow the US model because it’s “not working”.

The USA spends almost 18% of its GDP on health, more than three times the percentage recommended by the WHO. “The American system is the most expensive in the world, but it does not produce results,” said Dr Motsoaledi.

Better outcomes have been witnessed in countries which stick closer to the 5% recommended figure, but draw most of that from mandatory prepaid healthcare in the form of universal health.

Dr Motsoaledi reemphasised that NHI is not something that can be done quickly, and gave the example of how universal health coverage in some European countries took over 50 years to develop, and that in Qatar the system was planned out from 1991.

“We in South Africa are hoping to leapfrog some issues, but still, we cannot expect a short-term implementation, said Dr Motsoaledi.

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