Once the NHI is fully rolled out, medical aids will only be allowed to cover top-up services for which it doesn’t pay, and this section of the NHI Act (Section 33) is staying as it is, even if it costs South Africa its government of national unity (GNU), says Health Minister Aaron Motsoaledi.
“You can’t come and tell me ‘I support this universal coverage, but it (section 33) must go.’ It’s like supporting a house, but the foundation must go. Don’t you know it’s going to collapse?” Motsoaledi said in an interview for Health Beat, Bhekisisa’s TV show.
The logic behind it is for the total amount of money that South Africa spends on health – 8.24% of GDP – to be more equitably distributed: about half of the funds are spent on the benefits of patients with medical aid cover (15%) and the other half on the remaining 85%, who rely on government hospitals and clinics.
But it’s one of the issues about which the parties in the GNU – that don’t support the NHI in its current form – are most concerned, writes Mia Malan for Bhekisisa.
They view it as a potentially unconstitutional condition because it deprives the medical aid industry of the right to trade and takes away consumers’ choice to buy health cover from a preferred source.
For the DA, section 33 is a deal-breaker: expanded access to private medical aids forms the backbone of the party’s health plan included in its 2024 election manifesto.
The DA’s spokesperson, Matt Cuthbert, told Bhekisisa: “It was clear in the negotiation (process) with the GNU that a relook at the problematic clauses of the NHI Act would be essential to the GNU formation and its sustainability.”
Cuthbert said that in Cabinet discussions, it was agreed that a subcommittee would be established to process the views and alternatives.
But Motsoaledi stands firm: “We (the ANC) are not in an alliance with the DA; we just went into the GNU because the situation demanded it … If anyone believes because of this misunderstanding the GNU should collapse, that will be very unfortunate.
“But what can we do that would have been their choice?”
Should government and business talk more?
The future of medical schemes and also how the private healthcare industry will be used to give all South Africans good care, regardless of whether they can pay for it, were some of the reasons why Busa (Business Unity SA) and SAMA (South African Medical Association) refused to sign the second presidential health compact last Thursday.
SAMA has about 12 000 doctors as members and Busa is the largest federation of business organisations.
The first health compact, of which the goal was to better equip “the South African health system towards an integrated and unified health system”, was signed in 2019, and had remarkable co-operation from many sectors outside government.
Of the 363 partners, only 16 were state departments. Organisations such as Busa, SAMA, and the Progressive Health Forum, served on the steering committee, and helped to lobby other organisations in their fields to participate too.
Busa got 48 business organisations to commit to the agreement and co-ordinated the private sector’s contributions. SAMA, in turn, got 76 health professional organisations involved and managed input relating to primary healthcare services.
But this time around, only 13 partners signed the compact, of which three were the President, the Health Minister, and the Minister of Science & Innovation, because SAMA and Busa, among others, argued that the NHI was essentially being pushed down their throats.
Where references to the NHI in the first compact were few – the agreement had nine pillars and the NHI is mentioned in three, and only in relation to future implementation – the draft document circulated for input last week had 16 sections, and the NHI, as a clear policy to which all signatories commit, is mentioned in 12.
Ultimately, those who didn’t sign felt excluded. “It (the compact document) had been unilaterally amended by government, transforming its original intent and objectives into an explicit pledge of support for the NHI Act. These changes … were made without consultation,” Busa said.
The implication is that there are fewer partners to formally work together to improve the country’s health system.
One of the solutions to the medical aid issue, suggested by Discovery Health, would be amending section 33 to say “that the role of medical schemes will be determined at a later time through a collaborative and a consultative process”.
Discovery CEO Ryan Noach told Health Beat in July 2023: “That kind of amendment is only a few words in the Act, but … would lead to (the Act) being much more feasible and much easier to implement.”
Asylum seekers, migrants might get ARVs
Motsoaledi said although he was not prepared to negotiate on section 33, other parts of the Act, like the one about who will have access to HIV treatment, could potentially be changed.
Section 4 of the Act says asylum seekers and “illegal foreigners” can only get treatment for emergencies or notifiable diseases.
This section of the Act has previously caused outrage among health activists, because HIV is not a notifiable disease in South Africa and asylum seekers and undocumented migrants with HIV will therefore not be able to get ARVs.
Not treating everyone with HIV in a country doesn’t make sense, research has shown, because ARVs reduce the levels of HIV such that it becomes scientifically impossible for them to transmit the virus. Treatment, therefore, not only keeps people healthy, but also slows down the spread of the virus.
Motsoaledi disagreed, saying if “there’s a mistake in the NHI Act about that, it needs to be corrected”.
“If you refuse treatment to people with highly infectious diseases, like HIV, these will spread. Then you’re working in reverse.”
In fact, Motsoaledi said, laws are often amended. But in the case of the NHI, he will only sit down to listen to those who are open to change, and have constructive suggestions.
“I’ve been in government for ages. I’ve never seen an Act on earth that is never amended. But I’ve learned… that everything people don’t like, just by not liking it, they’ve given it a new name: unconstitutional.”
See more from MedicalBrief archives:
Organised business slams NHI emphasis in health compact
Motsoaledi to increase push for NHI
Why Motsoaledi trumped Phaahla to the top heath job