Potential NHI waiting times a likely threat to all health outcomes

How will the Department of Health manage appointment backlogs that result in the excessively long waiting times plaguing even the best nations that have adopted universal health coverage? This is a key question the Institute of Race Relations (IRR) has put to Minister of Health Dr Aaron Motsoaledi.

The United Kingdom’s National Health Service (NHS) is renowned for setting the world standard as a government-administered health-care service that is extensive and equitable. Yet even with this high standing, the NHS is far from desirable, primarily for its excessive patient care waiting times.

This could be South Africa’s fate under the National Health Insurance (NHI) scheme.

In Britain, the NHS has an 18-week target for non-urgent treatment. The 18-week maximum waiting time is meant to go from the moment a referral letter from a general practitioner or community health specialist reaches a hospital to when treatment is provided. This means that it should take four months at most for a patient to receive hospital care once the referral letter has been received.

However, despite the 18-week maximum, the NHS has never managed to keep waiting times from not reaching as long as 52 weeks (a year). Looking specifically at orthopaedic care at one of the NHS’s hospital trusts, namely Gloucestershire Hospitals NHS Foundation, the facility's website indicates that the cumulative average waiting time for treatment after receiving a referral letter is 37 weeks, or nearly 9 months.

One of the consequences of this has been the rise of medical tourism, which many people have opted for out of dire need rather than a desire to travel. The number of people seeking medical treatment abroad soared during the Covid pandemic, although the pre-Covid figures are just as concerning.

It was reported that the number of patients leaving the UK for medical care abroad, and so evading NHS waiting times and backlogs, rose from 152,000 in 2018 to 234,000 in 2021. By September 2023, a record 7.8 million UK patients, over 10% of the population, were on the NHS hospital waiting list.

The Canadian version of universal health coverage, medicare, is no better. In 2023, Canada’s median waiting time from GP referral to treatment was 27.3 weeks, or roughly half the year. In some regions, such as the Prince Edward Island province, the cumulative waiting time, including from referral letter to specialist treatment, was over a year, at more than 64 weeks.

Says IRR Campaign Manager Makone Maja: “Imagining what this could look like under the NHI is terrifying. While it is true that relatively few people have medical aid and can afford private health care, what the NHI offers as a solution is to worsen everybody’s access to good health care and consequently worsen all health outcomes equally.

“The IRR would like Dr Motsoaledi to heed the call to fix the current public health system instead of exposing South Africans to a whole load of issues that countries with far better resources and facilities to carry out this version of universal health coverage fail at. As a medical doctor, the Minister surely has a far greater understanding than most that quality health care cannot be divorced from keeping waiting periods to a minimum, as this can often mean the difference between life and death.”

Media Contact: Makone Maja, IRR Campaign Manager Tel: 079 418 6676 Email: makone@irr.org.za 

Media enquiries: Michael Morris Tel: 066 302 1968 Email: michael@irr.org.za