The National Health Insurance (NHI) will be introduced in phases, with room for private sector collaboration to ensure improved healthcare access for all South Africans, senior Health officials told a meeting this week.
People should embrace rather than panic about NHI and consider engaging with it and exploiting “the abundant opportunities that will emerge from the programme”, said Dr Mark Blecher, chief director for health and social development at National Treasury, and Dr Anban Pillay, Department of Health’s Deputy Director-General of health regulation and compliance, adding that there was potential for collaborative opportunities within the NHI once it is implemented.
They was addressing a round-table discussion in Pretoria organised by the European Union Chamber of Commerce and the Innovative Pharmaceutical Association South Africa (IPSA) last week, attended by government officials, National Treasury, the Board of Healthcare Funders and several patient advocacy groups, reports The Citizen.
The gathering was an attempt to learn more about the NHI implementation, innovation around it and possible collaborations.
The SA Medical Association (SAMA) said there was widespread concern among private healthcare providers and funders that NHI was designed to keep them out of the system.
“It is very unlikely… it is not easy to do that,” said Blecher. “Private financing of healthcare is important to us. It’s difficult for government to take on that private financing, so … we’re going to continue to see a role for private medical schemes and a multi-scheme arrangement for many, many years.
“NHI will be implemented gradually and in phases in consideration of the budget. Its evolution will be gradual.”
“Healthcare provision should be prioritised among the many problems the country faces,” said Katlego Mothundi, MD of the Board of Healthcare Funders of Southern Africa, on the sidelines of the discussion.
“That’s why there have been many prescriptions about how much money should actually be spent. This recommendation from (the World Health Organisation) is that at least 8% of the GDP should be directed at healthcare expenditure. In South Africa, one could argue that we are above that threshold at about 8.5%, but it’s not equitable.”
He added that there seems to be an attempt to exclude the private sector from being part of NHI yet at the moment, it contributes exactly what the government is contributing to healthcare.
“I think there should be recognition that the private sector is also part of the healthcare services.”
Blecher reiterated that private health companies should not be concerned “that they are immediately going to be impacted in a … negative way”, reports the Mail & Guardian, and that the inclusion of private services as providers is going to move gradually.
He pointed out that South Africa has the biggest public health budget on the continent, accounting for about 14% to 15% of the national Budget.
“The total health spending in the country is around 8% to 9% of GDP. I think it will increase over time, as normally happens with NHI systems around the world, because health is just naturally a human priority and probably ultimately the biggest area of spend in the world, in many countries.
“In the Budget the Finance Minister tabled in Parliament, he attempted to raise taxes to add an additional R28.9bn to the sector, which has been under substantial pressure since Covid-19.”
Participants at the discussion stressed the need for more partnership and collaboration between the public and private sectors, with stakeholders expressing concern about the relationship between spending and outcomes.
“The Treasury is focused on spending reviews and spending efficiencies … and further work will be done on spending reviews,” Pillay said.
“We have to make sure the public sector understands what it costs to deliver a service because the NHI fund is going to transfer funds based on a particular utilisation … Evidence will be developed over time … the public sector will be funded in the same way as the private sector.”
He added that it would increase spending, “which will be good for the pharmaceutical sector”.
Pillay told delegates there would be various benefits accruing from NHI, and that “the deliberations are an opportunity for … to engage collaboratively with the process because it is a work in progress”.
Patient Advocacy Group CEO Kelly du Plessis raised the issue of little to no engagement with the public and with patients, reports BusinessTech Africa.
Apart from the obvious funding issues, a major stumbling block to providing proper healthcare was the lack of proper data that can be analysed and used in the formation of better services. “Without this foundation it would be foolhardy to even try, as services provided may not be remotely what is actually required,” Du Plessis said.
The Democratic Nursing Organisation of SA (Denosa) has also come out in defence of the NHI, saying South Africans should give it a fair chance, rather than predicting corruption and failure.
Denosa secretary-general Kwena Manamela said the union and its federation Cosatu had supported the NHI since inception, and was also part of the Friends of the NHI campaign, actively involved in countering what he described as a “negative narrative” dominating the public discourse about the NHI.
He told City Press it was important to distinguish between infrastructure challenges in the public healthcare system and the NHI’s core function, and that public confusion stemmed from a failure to distinguish between two separate responsibilities: healthcare delivery, which the NHI fund would cover; and infrastructure, which would remain government’s responsibility.
“Let the fund take care of people’s healthcare – fund it, pay for it – and let government take care of the infrastructure. Walls falling off, plumbing, roads: that’s not the NHI’s function.”
He said the NHI would help redistribute the resources more equitably, for example, by encouraging medical specialists to serve in under-resourced areas rather than concentrating in places like Sandton.
On corruption fears, he said: “Whether there’ll be corruption (or not) is another matter. We should not pre-empt corruption in the implementation of the NHI. We should allow it to come into effect.”
He acknowledged that Denosa was committed to improved working conditions for nurses, and that if there were a staff shortage, “we’ll go to the staffing norms with the department… we’ll fight with them”.
The shift towards a re-engineered primary healthcare model under the NHI would promote the prevention of diseases and reduce long-term pressure on the hospitals, he added.
“The greater use of preventive health services should not be seen as a burden, but a positive development.”
Legal minefield ahead
Meanwhile, potential courtroom hurdles are mounting up, with another one having just been added to the list.
According to research commissioned by SAMA and its legal challenge filed in the High Court this week, financing the ANC’s plan for universal health coverage will mean raising an additional R240bn-R270bn, and place an improbably high burden on SA’s small tax base.
SAMA said that raising this amount of tax revenue would require increasing VAT to 23%, instituting a 40% surcharge on personal income tax, and introducing a payroll tax of 13.4% or increasing corporate income tax from 27% to 45%.
These estimates are slightly higher than those released by Discovery last year, reports Business Day.
SAMA, which is the fifth organisation to fire a legal salvo at the NHI Act since it was signed into law in May last year, has asked the High Court to declare the Act unconstitutional and invalid, and set it aside, citing the Minister of health, the President, Speaker of the National Assembly and the Chair of the National Council of Provinces as respondents.
“Without the support of the doctors, the NHI cannot be implemented,” said SAMA CEO Mzulungile Theo Nodikida in his founding affidavit.
The expert report it submitted on the costing of NHI estimates that fewer than 490 000 taxpayers account for just under half (46%) of all income tax paid to the fiscus. If income tax were the sole means of financing the NHI shortfall, they would each have to pay an extra R229 000 a year, says the report from consultancy firm Value in Research.
SAMA’s case follows court challenges launched by trade union Solidarity, the Board of Healthcare Funders, the Hospital Association of SA and the SA Private Practitioners Forum.
While it echoes many of the previous arguments – that the Act is unconstitutional because it is vague, erodes the access to healthcare services now enjoyed by medical scheme members and tramples on the rights of doctors to practice their profession – it places greater emphasis on its impact on patients and healthcare professionals, arguing that its provisions will harm the people it aims to help.
Nodikida argued in papers that, among other points, the Act’s requirement that a patient always start with the healthcare establishment with which they had registered was impractical.
He drew attention to the Act’s silence on health insurance products, which unlike medical schemes are not barred from covering benefits offered by NHI, and argued that low-income households that pay out of pocket for primary healthcare will be prejudiced by the Act.
The Citizen article – Government reassures private sector on NHI engagements (Open access)
City Press – Nurses union backs NHI: 'Let's give new healthcare system a chance'
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