Q: Have the latest revelations of corruption in the department shaken your faith in a state-run single fund NHI?
A: No.
Q: How can you believe it won’t be looted when top officials in the department mandated by the NHI legislation to manage the fund are charged with corruption?
A: We don’t know whether they’re guilty yet. Second, the department of health will not be running the fund, it’s going to be a board of 11 people.
Q: Would you say corruption in the health department is systemic?
A: It’s no different from the rest of society.
Q: We’re talking about a department whose top officials and a minister have been implicated in serious corruption.
A: There was a free-for-all created by a change in the procurement process which should never have happened.
Q: Shouldn’t this be a warning about the vulnerability to corruption of a central, state-run NHI procurement fund?
A: You don’t design a system around a handful of people who may or may not have particular characteristics. You design a system because that system is necessary to effect changes and efficiencies that are not in the current system.
Q: Does the state of the current public healthcare system suggest that a state-run monopoly will deliver quality universal healthcare?
A: NHI is not designed to deliver or provide healthcare, only to pay for services. Public and private providers must still actually provide the care.
Q: The same public providers who are clearly incapable of doing so?
A: If you pay for healthcare in a particular way, you get a particular behaviour. So what the NHI tries to do is change the way that we pay for healthcare. It’s only about financing.
Q: We still don’t know what it will cost, do we?
A: We know that the current expenditure this year, public and private, is likely to be in the order of R650bn.
Q: Are you concerned that the finance minister didn’t show much support for NHI in his budget?
A: That depends on how you interpret it.
Q: Instead of scrapping medical aid tax credits, as you wanted, he increased them, didn’t he?
A: We didn’t ask for that this year or next. We were asked in the appropriations committee and explained that it needs to be withdrawn slowly.
Q: Instead of which, he’s increasing them?
A: That’s actually going to work to our advantage
Q: Aren’t they supposed to be a main revenue stream for NHI?
A: Yes, but when we get to the point that tax credits can be withdrawn, if there’s a greater amount, then more money will come into the NHI, won’t it?
Q: You’re not concerned about dwindling support for NHI from the Treasury and government?
A: Who’s government? Parliament passed the act.
Q: The coalition government hasn’t been so supportive, has it?
A: We’re not at the stage of implementation yet, are we? We don’t have a board, we don’t have a... there’s nothing.
Q: So it’s pie in the sky?
A: No, it’s not pie in the sky; it just hasn’t switched on yet because you have to have sections of the act promulgated first. As you know, the state has agreed to pause until the Constitutional Court has ruled on the public participation challenges.
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