National Health Insurance, can SA afford it?

According to the World Health Organization (WHO), the USA has the highest per capita spend on health care, at a staggering $US6,719, and second behind the USA is the Principality of Monaco at $US5,585. Interestingly, the US spends an equivalent of 15.3% of GDP on health care, while Monaco spends only 4,5% of GDP on health care. According to the WHO, South Africa ranks number 67, in terms of absolute expenditure on health care, at $US715, behind countries such as The Seychelles, Mexico, Botswana  and The Bahamas. South Africa's expenditure on health care as a percentage of GDP is 8%, higher than Monaco.  

Wealthier countries such as the US and Monaco can afford to spend more in absolute terms, on health care than poorer countries, simply because individuals in wealthier countries have more disposable income. At 8% of health care spend as a percentage of GDP and at the current rate of economic growth, South Africa can not afford to spend much more on health care without severely affecting expenditure in other critical areas, such as housing, food and transportation. The soon to be promulgated National Health Insurance (NHI) will certainly require increased expenditure in health care. A national health tax has been proposed to fund the expected additional costs related to the NHI. South Africa already has among the highest personal taxes in world, which means that either the overall tax rate, as envisaged in the NHI, will increase or other areas which are currently subject to taxation may have to be traded off, so as to keep the effective tax rate at current levels, rather than increasing it.

Government may want to consider diverting a portion of the taxes levied on petroleum products, liquor, cigarettes and a slice of Value Added Tax, towards a fund for the national health programme. More taxes to fund the health requirements of the country, are simply going to make the country poorer. 

SA Government and Technology

The recent annual government ICT conference, GovTech, hosted by the State Information Technology Agency (SITA) was interesting and informative indeed. On the one hand I was left encouraged by government's willingness to embrace ICT and to use technology as a platform to improve service delivery to the citizens of South Africa. While on the other hand, I was left rather disappointed with how far government still has to go to fully leverage techology to improve service delivery to citizens.

Embracing Technology

The conference saw many topics being discussed, ranging from cloud computing to social networking as a way for government to connect with the citizens. There seems to be a much stronger position from the office of Minister Baloyi that SITA must play its rightful role of being government's primary systems integrator. Since its establishment, SITA has found it difficult to get state entities to utilise it in a manner that was envisaged in the law that was put in place to create SITA. However, SITA itself seems to recognize the role of partnerships with the ICT private sector to fast track government's adoption of ICT in service delivery.

Challenges

Government departments continue to have separate IT systems which operate separate from each other, which means that the integration of systems and therefore the information which resided on those systems remains a pipe-dream. In a nutshell, the SA government seems to be struggling to deploy and leverage technology for itself and its own employees, let alone using technology to engage with citizens. In my view, a critical factors towards the success of government using technology to improve its service delivery, is the deployment of a centralized database which allows for a single view of each citizen across all areas of government.

Beautiful Joburg

Joburg CBD

The picture above shows the skyline of Joburg downtown. Joburg is a really a beautiful old city and this beauty often masks the poverty and suffering that lies deep within the city. While South Africa and specifically Joburg is the most affluent place on the African continent, many Joburg citizens and many other people across South Africa live below the breadline. 

Take a closer look at the picture above, focus on a dark spot towards the mid-left at the bottom of the picture in line with one of the pillars, that dark spot is a homeless person who has found refuge in this hidden part of the city. Take my word for it, that dark spot is a homeless person, I know because I took the picture. Talk about living below the breadline, this guy will be lucky if he ekes out a living from bread crumbs.

Despite our wealth, South Africa still has a long way to go before the wealth is spread equally and perhaps this state of equilibrium will never be reached in our lifetime, however this does not mean the government of President Zuma should stop trying harder.