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The NHI is not the ideal solution for South Africa – Dr Rapiti, Cape Town, May 27, 2024
This past week I came to grips with the damning reality that healthcare of patients in South Africa is lamentably stripped of all human dignity after listening to the horrifying experiences of two of my patients.
The first patient was an elderly 69 year old female that presented to me with a one month history of abdominal pain and severe weight loss after she was seen by a state doctor.
I diagnosed her with severe Colon cancer and severe anaemia and sent her off immediately to a tertiary hospital.
A diagnosis of advanced colon cancer was confirmed and she had an operation to remove the cancer.
She returned to me for a follow up ten days later looking amazingly well. She was given an appointment for chemo in two weeks. She was extremely reluctant to return to hospital fearing that she will be admitted again.
I found her reluctance a bit puzzlingly until she informed me about an elderly female in her ward that was raped and assaulted in the early hours of the morning, when the ward was quiet.
The raped woman was apparently in severe pain, crying helplessly, alone, because the nurses wanted to hush the incident by saying to the senior in charge that the patient was mad and making up stories. My patient was recovering from surgery so she couldn’t do or say anything fearing that she might get reprimanded for speaking up.
My second patient was the experience of a 13 year old male, whose mother took him to a private hospital. He was diagnosed with acute appendicitis. She opted to go to the local district hospital with a letter from the private surgeon for financial reasons.
At the district hospital, the child was in severe pain. The mom’s pleas for help for her son were totally ignored.
The doctors on duty became verbally abrasive towards her and refused to attend to the child, after they waited for four hours.
The mother, out of desperation, asked to discharge her child because she was getting no help from anyone.
After putting up quite a fight with the doctors and being forced to sign a letter of responsibility, the mother took her child to another private hospital.
To avoid the high cost of admission, the child was treated as an out patient on intravenous antibiotics and sent home on a course of antibiotics.
The mom liased with me telephonically for the greater part of the evening sharing her entire experience at the district hospital and poured out her frustration about her dreadful experience.
These two cases are just the tip of the iceberg. Not a day passes when I don’t hear how patients in our state hospitals are treated with total impunity by young, inexperienced and arrogant doctors and callous nursing staff, who think that they are doing the public a favour to treat them.
My patients’ experiences at state institutions have unfortunately become the norm with a very few exceptions.
When our president, Mr Ramaphosa announced that the NHI was ratified to ensure that there was equality in health services, he was using one of the oldest tricks in the book that desperate politicians used and that was to make the tallest promises to the most gullible and vulnerable sectors of society just to remain in power. No one really took him seriously after Phaphla Phapalha incident and his cabinet’s botched up COVID policies.
My history fighting for an NHI
Before I delve into my reasons for expressing my negative views about an NHI for South Africa, I would like to go into a bit of my history about my involvement in the fight for an NHI for South Africa.
My struggle years in health care
Back in the early eighties, as a young doctor working in Mitchells Plain, I became a strong advocate fighting ardently to correct the injustices of the apartheid in healthcare.
I joined and became the chairperson of the Cape Town branch of Namda (The National Medical and Dental Association) which was an opposition health movement to the HPCSA and the South African Medical Association.
NHI was the favoured solution to our iniquitous health care system
At that time, we felt that the British NHS was a good way to solve the problems of inequality in health care.
1992 -I wrote a plan for an NHI
In 1992 after being the founding member and chairperson of a dispensing doctor’s association, I felt that I had acquired sufficient experience to write out a simple NHI plan for South Africa.
This plan, though still very applicable now, never took off due to battles with my colleagues in the medical fraternity.
Achieving independence
In 1992 we were on the brink of becoming an independent nation. I fondly remember purchasing a house, in a white area after I was given a permit without much effort.
The ANC and its famous leaders were admired and revered as the ethical, moral, honest leaders that were going to take us out of abject poverty into freedom, prosperity and peace.
They presented themselves like untouchable God-like figures, who apparently had all the answers.
Exiles with foreign accents
For the first time, we were lectured on how to run the country by exiles, who spoke with American and English accents. Local heroes, who made huge sacrifices fighting in the country knew far more than these exiles with their fancy accent but the local heroes were shoved aside.
30 years on – what have we learnt
The ANC is not a smidgen of the party that we thought it would be. Its presidents have been implicated in a huge list of scandals and corruption; the party became embroiled in huge amounts of infighting amongst the various factions along tribal lines.
Corruption was and is totally rampant in the party. State owned enterprises like SAA, Eskom, railways and harbours, water and sanitation, road services, health care, education, law and order and the judiciary, as well as the majority of the municipalities have all become bankrupt.
All these institutions have become opportunities for ANC ministers and ANC cadres and their families to become unqualified tenderpreneurs amassing huge amounts of wealth for themselves and their families whilst sending our nations coffers into a state of irrecoverable bankruptcy.
World experience with the NHI and NHS
Thirty years down the line all the once successful NHIs in Britain, Canada, Australia and New Zealand are failing dismally.
People in these countries have to wait two years for operations; in Canada, people are openly given the opportunity to end their lives with the states help .
Doctors are fed up with the NHI and NHS and are leaving because of all the red tape that they are constantly subjected to.
COVID made things worse
Unscientific COVID policies, driven by big pharma’s greed for profit coupled by costly wars in Europe have forced the world into an irrepressible depression and recession.
Why NHI won’t work
In order for an NHI to work we need to reduce our unemployment rate from 50% to 10%.
Out of a population of 60 million residents and a few million non-taxpaying foreign nationals, the NHI will have to be funded by a mere 7 million people with taxable incomes.
It would be absolutely impossible to get an NHI that promises the lofty ideals of equity and equality off the ground with such a small tax base.
Lack of human resources
We do not have enough staff to run such a huge undertaking. The majority of the current stock of doctors will leave the country because no one would want to work under ANC appointed administrators, who don’t have a clue about healthcare and medicine.
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Doctors stifled
One of the major problems for doctors working for state and private institutions like Medicare in the US is that the administrators of these institutions frequently interfere with doctor -patient relationships and interfere with a doctor’s right to think critically.
Prof Paul Marik, in the US was fired from his hospital because he used cheap unconventional methods to save patients from dying of COVID, when costly conventional methods were killing patients.
I could not have saved any of the 3000 COVID patients that I treated if I had to follow the WHO’s guidelines on how to treat COVID. I was able to exercise my rights to be innovative and to do no harm to save thousands of people from dying of COVID in my practice and around the world with my approach with a 99.97% success.
NHI – a cesspool for corruption
Running a successful NHI given the huge financial and human resources required to run it, will make the NHI a huge cesspool for corruption in magnitudes far in excess of what we witnessed in all the SOEs run by the ANC in the last thirty years.
Using existing medical aid funds
The government is being terribly naive if they think that they can control medical aid funds.
No one will belong to a medical aid if they are going to join huge queues in our defunct state hospitals.
The state does not care for 80% of the population
An often mentioned myth is that the state cares for 80% of the population.
Cash patients make up 50% of a gps patients in townships.
Even pensioners attend GPs instead of waiting a year to see a state doctor.
Opposing an NHI is not being against inequality
I have presented several cogent reasons why the NHI model contrived by the government’s think-tank won’t work but that does mean that I am opposed to equality.
Equality in health can never be achieved if we remain a totally unequal society. High unemployment rates, the huge disparities in income between workers and managers, the heavy tax burden on individuals and high cost of living are major factors that are contributing to the gross inequality in the country.
The word equality is highly misplaced and totally unachievable in an unequal society.
The word equality should be replaced with the words: treatment in accordance with affordability.
We cannot avoid a dual system in a capitalistic society
In a democratic society, people should have the right to purchase health according to their means for practical and logistical reasons.
Spending on health is not a sign of extravagance but are a sign of being responsible. What right does the government have to stop a mother from obtaining health from the private sector to save her son’s life when the state doctors just couldn’t care?
Given the complexities of healthcare, governments all over the world are totally incapable of running healthcare systems in a cost-effective manner, so they should butt out of the everyday running of essential services like health and other services to citizens.
Cost of a primary care visit
The cost of an excellent visit to a primary care doctor for a patient with a number of chronic illnesses for consultation, examination, basic investigation, medication/treatment is between R400 to R500 in about 15 minutes with a waiting period of thirty minutes.
High cost of care in stste hospitals
The cost of seeing a patient in a state hospital for five minutes after a 12 hour wait can costvin the region of R2000 if all the incidental costs are included. The state could save vast sums of money if it buys these services on a capitation basis from GPs.
Hospitals and specialists drive up costs in private healthcare
The huge cost of private healthcare care is driven by the exorbitant fees charged by private hospitals, specialists and unnecessary Investigations.
GPs only account for only 6% of the total bill of medical aids. GPs are paid the least even though they play a significant role in the well-being of patients.
GPs have always been abused by medical aids
Medical aids have abused GPs over the past few decades by not remunerating them for effort ECGs, lung function tests, side room tests, Pap smears, procedures like nail resections, intra-articular injections, circumcisions and major abscess drainages. Can GP expect any better when their IPAs dance to the tune of the medical aids.
Medical aids willingly pay big hospitals
Medical aids would gladly pay hospitals R20,000 for procedures GPs can do in their rooms for R1000 or they will pay specialists R3000 for ecgs but pay GP s nothing.
If GPs were paid better, we could get a better standard of service for much less and improve outcomes of chronic conditions through early intervention and proper monitoring.
Medical aids – Profiteering from healthcare
Medical aids are probably the biggest drivers of healthcare costs. Almost all of them are making a killing from membership contributions.
Discovery has proudly announced that it made R9 billion in profit but their members are the most disgruntled with their services.
Change the model of medicine
If prescription medication is the third leading cause of death in the US then it is time we changed how we treat our patients and how we teach our doctors.
Is there a Solution?
My resounding answer, as someone with a longstanding interest in health care systems, is a resounding YES, because I have been extremely passionate about the delivery of good quality healthcare that is affordable, accountable and sustainable without government interference.
My solutions for a good health care system are as simple and cost-effective as my approach to COVID.
Unfortunately, we live in a world, where people like me have no platform to share their ideas for the greater good of society.
I shall wait patiently, as I have done for the past thirty years, to help to solve our healthcare problems, if I find people willing to listen to me.
Finally, the NHI will never leave the board rooms after the ANC has lost the elections and it will be business as usual.
It’s anyone’s guess who will be our next president when Ramaphosa decides to retreat to the peaceful world of farming,
tending to his prize buffaloes unless he becomes a salesman for Gates selling LAB meat instead of leading his flock into the opposition benches.
Dr E V RAPITI
Cape Town
Sunday, May, 26, 2025
Dr Rapiti is family physician, practicing in Mitchells Plain Cape Town for over42 years.
He has an MBA in health policy and has written the primary care part for an equitable health care system for South Africa in 1992.
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