Health system reform is both necessary and possible, says UCT public policy Professor Anthony Butler, adding poorly run and exclusionary health systems undermine education, discourage entrepreneurship, reduce worker productivity and slow economic growth.

As a result of sensible reforms, he notes, middle-income countries such as Thailand, Chile and Costa Rica now enjoy health outcomes similar to those of high-income states.

‘However, despite the imperative and potential benefits of reform, there is little relief to be found in the National Health Insurance Bill that has finally concluded its tortuous journey through Parliament’s legislative process. This is a deeply disappointing product for a decade or more of deliberation.’

In his opinion piece in Business Day, Butler points out a number of problems with the legislation:

* It does little to nothing to tackle the key determinants of SA’s poor health outcomes.

* It will not divert resources from ineffectual treatment programmes towards prevention and health-building initiatives.

* It will not dent growing obesity, cardiovascular disease and poor nutrition.

* It will not improve an education system that denies young people the knowledge they require to look after their own health and that of their children.

* It will not resolve the epidemics of HIV/Aids and drug-resistant tuberculosis, reduce the toll of traffic accidents, or prevent violent deaths attributable to alcohol.

* It will not create social support systems to reduce the burden placed by the old and vulnerable on expensive health facilities.

* It will not address basic and appalling problems of mismanagement and corruption in the public health system. ‘Even many strong proponents of an NHI have noted that the proposed reforms are likely to invite further corruption.’

Butler notes while the Bill falls short of our most basic expectations of credible planning – finance and implementation – the key constraints on health system intervention are human rather than financial.

‘The NHI proposes breathtaking changes in the organisation and everyday activities of health sector workers. Yet there is no credible strategy for securing support – or even acquiescence – from the extremely mobile health professionals on which the system will depend.’

He says opponents of NHI are mostly motivated by anxiety – ‘and it is perfectly understandable to be scared of dysfunctional public hospitals and clinics.’

He adds this ‘stubborn’ political fact will probably ultimately defeat the dogmatic champions of the current iteration of NHI.

‘Hopefully there is still time and space to return to more productive deliberation about how to realise the potential gains universal access can bring.’

Full opinion piece in Business Day