SAMJ 7114

Affordability of National Health Insurance … and definition of a billion

To the Editor: I would like to comment on an article about South Africa’s future National Health Insurance, written by Dr Stephen Craven and published in the Cape Doctor of April 2013.1 Dr Craven states, ‘The expense of the National Health Service [in the UK] is colossal. There is no cost control. The total budget for 2010-11 was £107 billion which, divided by 63.1 million (the 2011 population), comes to the more comprehensible £1.7 million per head.’

The confusion comes in the definition of a billion. The UK used to define a billion as a million million, but changed to the US definition of a thousand million. Using the same figures quoted by Dr Craven, this means that the NHS costs £1.7 thousand per head of population, not £1.7 million. This is in keeping with the figure of £1 979 per head given on

Jenny Edge

Christiaan Barnard Memorial Hospital, Cape Town, South Africa

    1. Craven S. The argument against National Health Insurance. Cape Doctor 2013;April:1,2,5.

    1. Craven S. The argument against National Health Insurance. Cape Doctor 2013;April:1,2,5.

Dr Craven responds: While researching my article, I looked at my Concise Oxford Dictionary and noted the two definitions of ‘billion’, viz. a million million in England and one thousand million in the USA. In good faith, I used the English definition that I had been taught at school. All the sources I read and cited were written in England and South Africa, and published in journals in those countries where English is spoken and written.

The alleged error does NOT alter my conclusion that National Health Insurance is unaffordable, unachievable and unnecessary. If the politicians and their health economists should surreptitiously delete three zeros from the long-established definition to conveniently support their unaffordable policies, it confirms their unacceptable behaviour.

Stephen A Craven

Hon. Lecturer in Family Medicine, University of Cape Town, South Africa

S Afr Med J 2013;103(7):435. DOI:10.7196/SAMJ.7114

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