NEHAWU responds to Econex report

I have included my comments below on today's Business Report article on NEHAWU's irate response to yesterday's Econex report. Maybe it's just me, but I feel that NEHAWU is not angry with Econex over any substantive issue - NEHAWU seems angry that the NHI was once again predicted to cost a fortune and that Econex dared to question the viability of a project so essential to the welfare of South Africans.

NEHAWU outraged by NHI study
February 16, 2010
Source

The National Education, Health and Allied Workers' Union (Nehawu) on Tuesday slammed the research by consultancy Econex into the proposed National Health Insurance (NHI) scheme.

The research was "yet another guesstimate exercise" purporting to be a credible study on the costs of the NHI, the union said in a statement.

Nehawu said the research had been commissioned by private hospitals -- "hardly a reassuring indication of objectivity".

"Wild and unfounded claims on the supposed costs of the NHI are made in the report, including the usual claims about the possible tax implications, a ploy intended to scare off the taxpayers for ulterior motives of those who currently take the largest share of our country's health budget to service their selfish interests as opposed to improving health care to a large majority of our people."

Quite the opposite, in fact. I think that producing initial estimates of the likely cost of the NHI is in everyone's best interests, including those of the "large majority of our people". This research is the best cost analysis available to date with the information that the Government has released on the NHI.

According to the study, government will have to provide an extra R244 billion a year, in addition to the money it already spends on health.

"The proposed NHI in its current form, promising universal coverage, no co-payments, comprehensive cover and provider of choice, will be massively expensive," Econex said in its research note.

However, the union said Econex economist Marine Erasmus had allegedly confirmed in a radio interview that the estimate of an extra R244 billion a year was based on only two leaked documents and one public document from ANC Today.

"She has in the same interview confessed that she has absolutely no idea of what the detail is."

If Econex has used limited information to draft this report, then whose fault is that? It is the Government's fault, for failing to release more useful or accurate information to the public. No member of the public knows what the details of the NHI proposals are because no documents other than those above have been released.

"However, the report acknowledges that the researchers based their costing of the comprehensive cover on the current private healthcare costs believing that there would be a greater shift towards the use of private healthcare."

Nehawu said it rejected this assumption as private healthcare was not available to people living in remote areas "and in any case the NHI is not going to be based on the current private health costs which are distorted by profiteering and inefficiencies".

Once again, "freedom of choice of provider" is the promise that Government has been delivering to South Africans. It is therefore natural to assume that the majority of demand for hospital services would be channeled to the excellent private sector.

Having said that, it is true that a mix of public and private healthcare will be consumed under the NHI, and this should have been allowed for in the report.

On "distortions from profiteering and inefficiencies", there is little empirical evidence to suggest that public healthcare can be provided more cheaply than private healthcare, although a common rule of thumb is a 30% discount in the public sector. In any case, the Econex report does allow for such a reduction in costs.

The union said Econex had indicated the additional revenue needed for the NHI would amount to a 33 percent to 37 percent increase on total tax revenues.

"However in [the] interview, Erasmus stated that it would be difficult to say how much additional income tax would be required given the little detail we have at the moment", the union said.

It rejected Econex's suggestion that social health insurance, where only employed people would be covered, might be the best option as an interim step towards a full NHI.

Nehawu said this would once again "remove the focus of health delivery from workers and the poor" and this was not in line with the constitutional injunction which expected government to ensure access to healthcare to all.

Quite the opposite. Regardless of what NEHAWU would like, the introduction of NHI would have to take place in phases, or the introduction of NHI will almost certainly fail. Introducing the system in phases brings the poor closer, not further, from coverage.

"Distortions and misrepresentations about a people's health are not only unethical and irresponsible but they are also a health hazard as their poisonous effects can penetrate the minds of the policy makers and implementers," Nehawu said.

So true.

It challenged Econex to clarify the basis of its calculations and to inform the public as to who sponsored the research.

I would also like to see Econex release some more of its assumptions.

"Until the final policy document has been confirmed by Cabinet and released for public comment by the minister of health, the assertions from Econex and similar institutes remain guesswork," the union said.

Very important and useful guesswork that is conducted with the best of the available information at the public's disposal.

While Finance Minister Pravin Gordhan may mention the NHI in his first budget speech on Wednesday, he was not expected to announce the launch of the scheme.

The plan is still regarded by most economists as being in its infancy. - Sapa