Hon Chairperson, hon Minister of Finance and Deputy Minister, hon members and special delegations, there is no doubt that the current health system in South Africa is discriminatory and harms the poor people of this country. So, no one has more at stake in the political debate over how best to shape the health care reform in this country than the poor people themselves.
After so many years of unequal treatment in this country, the poor people, the majority of whom are black, are forced to continue accepting health care and health outcomes that fall short of the quality and availability of medical services provided to more advantaged groups. So many have been made to suffer for so long, with so little, by so few.
Inequities in health are accompanied by disparities in health insurance coverage. Poor people have the highest rates of insurance. The lack of quality, affordable coverage makes them less likely to receive medical care and more likely to fall into poor health and die early. This is simple logic, and you don't have to be a rocket scientist to come to this conclusion. The medical establishment bears a major share of responsibility for this institutionalised racism, and it is about time our government did something about it. That is the reason we support the government's National Health Insurance, NHI, scheme.
Chairperson and members, health care is a human right. This is a widely accepted international principle. This right should not depend on how rich we are or where we happen to live. The right to obtain health care is written in our Constitution but despite this large numbers of our people continue to die prematurely and to suffer unnecessarily from poor health. Treatable conditions are not being treated on time and preventative diseases are not being prevented. This is in spite of the fact that government has tried its utmost since 1994 to ensure that everyone in this country has equitable access to necessary health care services.
There are still serious challenges, mainly caused by a skewed health care financing system. Without the NHI, the burden of diseases in this country will not be reduced because the majority of the population and the section suffering the greatest ill health will not access good quality health care. We must think of those people who still go and scratch around the dumping areas, and the food that they eat is contributing to their death. Even if we travel to other countries, we have never actually taken the time to go to the most rural areas where people still dig around the rivers to try and get whatever they can put down their throats to eat.
Chairperson, allow me to clarify the distortion that is often made with regard to how the NHI scheme will work. There are a few people who confuse many with assertions that the NHI is all about destroying the private sector and that private care providers will be forced to contract with the NHI. Of course this is not true. Government does not intend to abolish private medical schemes if individual members wish to keep them. Also, participation in the NHI is solely a matter of choice for the individual health care provider.
There is also confusion perpetrated by these few with regard to how people will participate in the NHI. We need to make a distinction between a citizen participating in the NHI as a contributor and a citizen participating in the NHI as a patient. If you earn above a certain income, you will be required by law to make a contribution to the NHI fund. It will not be possible to opt out of this responsibility; however, as a patient, if you wish to make use of the services of a health care provider who is not accredited and/or who chooses not to contract to the NHI, you will have to pay the provider directly or else maintain medical scheme cover in addition to making NHI contributions.
Chairperson, the deplorable health conditions that so many of our people find themselves in should be viewed within the context of the bigger picture of social services. Therefore, substantial improvements in health and life expectancy will have to be achieved by addressing the social determinants of health, including a clean environment, occupational safety, safe neighbourhoods and access to nutritious food. Therefore, we should see the NHI as but one of many interventions that we must still make. A high- performing health system must deliver quality care to everyone, regardless of race, ethnicity, sex, income, or any other demographic characteristic. This is what is expected by our Constitution.
A lack of health insurance disproportionately hurts the poor and low-income families because health insurance in South Africa remains linked to employment. Higher-paying jobs tend to offer more comprehensive medical coverage, while lower-paying jobs, disproportionately occupied by many black people, tend to offer limited, if any, health benefits. Even when low- paying jobs do offer benefits, they are often accompanied by expensive cost- sharing arrangements with employees.
The discriminatory health services in South Africa have gender elements too, because twice as many women as men rely on their spouses for health coverage. Women increasingly find themselves uninsured, underinsured, or with unstable coverage. Given that women generally use more health services than men, women are more likely to delay necessary care, because it is unaffordable or difficult to find, and that leaves them vulnerable to greater medical debt than men.
The other vulnerable section is the people in the rural areas. These people are also burdened by structural barriers that, lead to poorer health outcomes. Levels of poverty in these areas combine with the scarcity of medical services to create worse outcomes than in urban areas. Therefore, rural residents have higher rates of infant mortality, pulmonary diseases, chronic disease, cardiac disease and trauma deaths, etc. The same challenges, if not more, are faced by people who live in the informal settlements.
In supporting the allocation for the piloting of the NHI, we are not saying that this is enough. We are saying that, understanding the limited resources that we have, this little will go a long way in helping so many to access the health system. This will not only help the poor socially but economically as well. As the ANC, we fully support the allocation for the NHI. I thank you. [Applause.]