The SA Medical Association has ‘deliberately’ not partnered with Business Unity South Africa (Busa), and funders in their ongoing negotiations with President Cyril Ramaphosa and the Health Ministry over revising NHI legislation.
The private sector protagonists, of which the SA Private Practitioners Forum (SAPPF) is a part, have put a combined legal challenge of the NHI in abeyance in the hope that the Government of National Unity will amend ‘deeply flawed’ sections of the NHI, as it did with the Basic Education Laws Amendment Bill.
SAMA CEO Dr Mzulungile Nodikida told MedicalBrief that the reason for not partnering in the negotiations was that SAMA had a ‘unique position/perspective as the largest representative body of doctors in SA which needed to be ventilated”.
“We have members in both the public and private sectors, general practitioners and specialists, junior and experienced doctors, those completing their studies and those academic doctors training the new generation. SAMA’s focus remains to unite doctors for the health of the nation, and it needs to put arguments that align with that vision before the court,” he said.
This would be via separate legal action not linked to any Busa court challenge.
The Busa delegation has revived mandatory health cover – the ANC’s original plan for achieving healthcare equity – as a faster and more financially feasible tool that will both expand private medical aids coverage and take pressure off the public sector. This is in stark contrast to the NHI which health economists estimate will cost an extra R200bn in various forms of taxes which the small taxpayer base may rebel against or avoid, leaving the already overburdened fiscus unable to help.
The Busa delegation met with the government team in mid-September, with President Cyril Ramaphosa asking them to formulate a more detailed proposal – now due to be presented within days.
The NHI legal framework, signed into law by Ramaphosa two weeks before the May elections this year, usurped his party’s post 1994 mandatory cover policy, aimed at maximising the carrying potential of medical schemes through measures that would remove discrimination based on health status and introduce systems of industry-wide risk pooling to counteract market failures and incentivise efficient competition. (A health insurance risk pool is a group of individuals whose medical costs are combined to calculate premiums. Pooling risks together allows the higher costs of the less healthy to be offset by the relatively lower costs of the healthy, either in a plan overall or within a premium rating category.)
Under mandatory health insurance, everyone who is in formal employment, or who earns above a certain threshold, would be forced by law to be a member of a medical scheme. This will result in medical scheme membership swelling dramatically and pressure being taken off the public healthcare system. It will also result in medical scheme premiums being reduced since more healthy, younger people will join the schemes.
In an unrelated development, the SAMA board is withdrawing charges of fraud and embezzlement against its Cape Western branch which allegedly used branch funds to seek a legal opinion against it. This follows the overturning of an internal SAMA disciplinary hearing which found all 13 of SAMA’s Cape Western branch council guilty of misusing funds, (R200 000), in a bid to legally render the board unconstitutional. The appeal ruling harshly criticised the SAMA board for both its verdict and sanction, and overruled both, (the sanction being that members apologise on pain of a three-year membership suspension, failing which they’d be suspended for 10 years.) It said the board had overreached, while admonishing the branch treasurer for not getting three quotes for an independent legal opinion, the acquisition of which it said was in SAMA members’ interests.
SAMA accepted the appeal panel’s findings, calling it a ‘learning exercise,” that would strengthen the association – but found themselves facing a branch letter demanding an official apology for reputational damage and recompense for a substantial sum spent on defending its members against the charges.
SAMA has just over 12 000 of SA’s 35 000 registered doctors as members, while the remainder are split into specialists, family medicine, managed care, and independent bodies.