Backwardness has its privileges. The people and governments of countries with pre-industrial methods of production in a post-industrial epoch can learn from the mistakes of more advanced countries to improve their future.
A recent example is the manner in which African countries have been able to fly from lack of landline telephones to ubiquitous mobile telephones. Another example could be modern and efficient healthcare systems accessible to all residents of an African country.
Most sub-Saharan African countries are notorious for spending small percentages of their gross domestic product (GDP) on the health care of their citizens.
Unlike residents of the so-called developed world, the typical sick African has no health insurance and modest governmental support. Indeed, we are world leaders in the proportion of our health care that we finance out of our measly monthly income. Our willingness and ability to pay for our own medical needs demonstrates that the healthcare market can be controlled by the individual consumer.
Health care reform is all the rage in South Africa and the United States of America.
President Obama’s approval ratings in the US have dropped as the temperature of the health care debate has risen.
The African National Congress (ANC) has vowed to introduce a national health insurance system sometime in 2010.
President Obama wishes to ensure access to decent health care for all legal American residents while the ANC hopes to raise the quality of health care services available to the majority of South Africans to the high standard enjoyed by its prosperous minority. All African governments should ensure universal access to decent healthcare for their legal residents.
An equitable national healthcare system provides every legal resident of that nation access to a minimum quality of modern hospitals and clinics, regardless of ability to pay; access to health care professionals chosen by those residents without lengthy delays; a competitive market for the delivery of healthcare services; and a lengthening life expectancy.
If a country’s political leaders are willing to be treated in that country’s hospitals, then those hospitals must be good. Medical tourism by African politicians in countries like Saudi Arabia does not speak well of African hospitals. Some form of government subsidy is crucial to assist poor people.
Some countries, such as the United Kingdom, or the plan proposed by the ANC, use a single state payer to introduce those subsidies. Most British people participate in that country’s National Health scheme, although individuals are free to procure additional services from the private sector. Other countries, like the US, the Netherlands, and Singapore use multiple payers-private and public. Maximum efficiency in the consumption of healthcare occurs when the consumer pays directly for most of his or her medical expenses. Paradoxically, it follows that Africans may be among the most efficient healthcare consumers.
According to the World Health Organisation, the US spent 15.3% of its GDP in 2006 on health matters. France spent 11%, South Africa 8%, Nigeria 3.8%, and Singapore 3.3%. The payments made directly by American patients to healthcare suppliers (whether hospitals or doctors or pharmacies or drug companies) constituted 1.95% of America’s GDP. Comparable ratios were 0.74% for France, 0.87% for South Africa, 2.41% for Nigeria, and 2.01% for Singapore.
I use life expectancy data to assess the efficiency of expenditure on health care. The US has a life expectancy of 78.2 years. France has 80.7 years, South Africa has 49.3 years, Nigeria has 46.9 years, and Singapore has 80 years. My healthcare efficiency ratios (life expectancy/healthcare expenditures as a % of GDP) are 5.12 for the US, 7.34 for France, 6.16 for South Africa, 12.34 for Nigeria and 24.45 for Singapore.
It seems that the higher the percentage of a country’s healthcare expenses funded out of its resident’s personal income, the more efficient that country’s healthcare system. By my reckoning, despite having some of the best hospitals on earth, the US health care system is less efficient than that of Nigeria.
Africa needs to maintain its efficiency while improving the quality of its hospitals.
Singapore is unusual because it combines African efficiency with European high quality hospitals. It is compulsory for its residents to save for their medical expenses in medical savings accounts over a lifetime. Withdrawals from those accounts are made to pay for hospital and clinic visits.
Those savings permit the construction of superb hospitals. I believe that this savings feature should be introduced in Africa, with some subsidy for the indigent. Over time, those savings would finance the construction of excellent hospitals.
Then Africa can leap to the forefront of healthcare in the world.