Page 50 - IRMSA Risk Report 2020

4.3.5
ILL-C ONCEIVED NHI POLIC Y AND / OR SUB-OPTIM AL
IMPLEMENTATION

DUE TO PAST INEQUALITIES, POOR PUBLIC HEALTH CARE SERVICES AND LIMITED ACCESS TO PRIVATE HEALTH
CARE, AN ILL-CONCEIVED AND/OR SUB-OPTIMAL IMPLEMENTATION OF A NATIONAL HEALTH CARE SOLUTION MAY
NEGATIVELY IMPACT HEALTH CARE AND THE ECONOMY.

SCENARIOS FLAGS RISK RANKING OVER LAST 5 YEARS

Leadership RANKING SCALE
Institutional capacity 10 9 8 7 6 5 4 3 2 1
Politics
SPRING OF HOPE
Social cohesion
National policy
FAKE IT TILL WE MAKE IT...OR NOT? Service delivery ANNUAL RANKING
Inequality 2015 2016 2017 2018 2019 2020
NOT
NOT
NOT
NOT
NOT
Economy RANKED RANKED RANKED RANKED RANKED
PERPETUAL HANGOVER
Global trends
Climate
Based on the latest version of the NHI Bill, Gazetted on 26/7/2019 (Gazette no. 42598), it is envisioned that NHI will: create a
unified health system by improving equity in financing; reduce fragmentation in funding pools; make health care delivery
more affordable and accessible, thus eliminating out of pocket payments when individuals need to access health care
services; and ensure that all South Africans have access to comprehensive quality health care services.

TOP 5 CHALLENGES TO ACHIEVING TOP 5 RISK TREATMENT OPTIONS AND
TARGETS OPPORTUNITIES
1. Significant capital funding (at low rates) is required to build 1. Call on big business and international sovereign loans backed
proper public health care facilities. by Treasury to set up low cost/affordable capital funding to build
2. The biggest challenge is to find salaries to pay practitioners. much needed health care facilities.
There are more doctors in SA than the public sector can 2. Attract doctors from other countries that already run National
accommodate with the present budget. Hundreds returned Health Insurance.
after training in Cuba and about 1000 who complete 3. Robust stakeholder engagement plans and public awareness
community service annually need to be employed. campaigns.
3. High levels of distrust and resistance to change in both public 4. Set up proper governance, controls and monitoring systems to
and private sectors. ensure appropriate service levels and manage the potentially
4. Increased potential of “underservice” to save costs and stay higher corruption risk.
within budget and simultaneous the ability to remove the over- 5. Leverage technology (including AI) to ensure control of
servicing, duplication and waste in the private health sector. information, service levels, and costs across the value chain.
5. Inability to eradicate systemic corruption and/or deal with
labour issues in both public and private sectors.

FAC TS AND FIGURES

Hospitals in South Africa
• 405 acute public hospitals
• 25 psychiatric hospitals
• 35 infectious disease hospitals
• 9 others
Hospital beds in South Africa
• Public 90,000; private 40,000
Public spend on health care 2019/20
• R230bn
Private estimate
• R180bn

Source: Sources: Health Market Inquiry Report, September 2019.