NHI Bill ‘won’t be a silver bullet’ in saving public healthcare in SA

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NHIThere can be no dispute that SA’s health care system needs major reforms, writes Professor Laetitia Rispel of the University of the Witwatersrand in The Conversation. But the proposed legislation will be ‘no silver bullet’.

South Africa’s Health Minister Aaron Motsoaledi has finally gazetted the Bill detailing an ambitious plan to roll out universal health care in the country through National Health Insurance. The Bill responds to a global campaign spearheaded by the World Health Organisation and linked to the UN’s sustainable development goals to make sure that no-one is left behind in accessing quality health care.

Laetitia Rispel, the professor of public health and DST/NRF research chair, University of the Witwatersrand writes in The Conversation: “There’s no dispute that South Africa’s health care system needs major reforms. There are considerable inequities in health care between urban and rural areas; between public and private health sectors and between primary health care and hospital care. And the country has a complex disease burden with heavy caseloads of HIV, TB and non-communicable diseases.

“South Africa has poor health outcomes compared to other middle-income countries such as Brazil with similar health spending as a percentage of GDP. It spends more than R300bn – or around 8.5% of its gross domestic product – on health care. But half is spent in the private sector catering for people who are well off while the remaining 84% of the population, which carries a far greater burden of disease, depends on the under-resourced public sector.

“The health system performs poorly due to a combination of factors including the poor management of public sector hospitals, health professional shortages (particularly in rural areas), low productivity levels among staff, escalating private health care costs and poor quality of care.

“But in its current form the proposed legislation won’t be a silver bullet. There are still too many inconsistencies and unanswered questions for it to be the final roadmap to universal health care in the country. For example, the Bill focuses on curative services, missing an opportunity to take a public health approach that focuses on disease prevention, health promotion and health protection. In addition, it doesn’t address the relationship between the public and private health sectors which is seen as a major impediment to fundamental change.

“The Bill is informed by a vision of ensuring equitable access to quality health services, regardless of a person’s ability to pay or whether they live in an urban or rural area. The proposed insurance fund envisages the consolidation of public and private revenue into one funding pool. The idea is to enable a more equitable system through, for example, cross-subsidisation and ensuring that essential services are made available.

“All people will have to register as users of the fund at an accredited health care establishment or facility (whether public or private). And the fund will decide on the health benefits that the facilities will have to provide. This will depend on what resources the facility has. People will be able to pay for complementary health service benefits not covered by the fund.

“To be paid, health care providers, such as general practitioners and hospitals, will have to register with the fund. They will have to claim for each patient that they treat and will have to keep a record of diagnosis, treatment and length of stay. The structure that’s been proposed for the fund is raising concerns on two fronts: it appears unnecessarily cumbersome and there’s a lack of clarity on lines of command.

“The Bill makes provision for the fund to establish an independent board that will report to South Africa’s Parliament. But it makes no mention of how the board will engage with the health minister (political custodian) and public servants in the health department. Nor does it explain how the performance of the fund will be evaluated.

“The Bill also introduces two additional management layers: district health management offices and contracting units for primary health care. These units will provide primary health care services in specific areas. It includes a district hospital, clinics and community health centres as well as ward-based outreach teams and private primary care service providers. They will be contracted by the fund.

“National, provincial, and municipal health departments will still exist. But the Bill fails to explain the relationship between the district health management offices and the contracting units and how they will engage with the national, provincial and municipal health departments. Given that there are ten health departments operating in South Africa – a national department and one in each of the country’s nine provinces – these additional offices and units could result in a more cumbersome bureaucracy. This could lead to more inefficiency and greater opportunity for corruption.

“The new structure will also change the responsibilities of provincial health departments. Some of the proposals don’t make sense such as the idea that municipalities should take control of managing communicable diseases. Ideally this should be a national function, given the serious threat that is posed by some infectious diseases.

“Other parts of the Bill are also unclear. These range from financing to how complaints will be managed.
Health financing and management: The Bill doesn’t explain what the tax implications of the national health insurance will be for citizens. It also doesn’t set out the mechanisms that will be put in place to strengthen financial planning and monitoring systems, particularly in the public health sector. These are very important given current chronic overspending, inadequate financial management and corruption and lack of accountability in many provincial health departments.
Service provision: The Bill says everyone is entitled to a comprehensive package of services at all levels of health care. But it doesn’t spell out what these packages will include. Given budgetary constraints, it’s obvious that there will inevitably have to be trade-offs and difficult choices.
The health workforce: South Africa doesn’t have a comprehensive health workforce strategy with detailed norms and standards. This remains the Achilles heel of health sector reform in the country. The lack of detail remains a serious omission in the Bill.
Complaints mechanisms: The Bill introduces a new separate complaints directorate – the investigating unit. But it’s unclear whether this will be the first level of complaints or whether it’s a duplication of the complaints directorate in the existing Office of Health Standards Compliance. There also isn’t clarity about where the Health Ombudsman fits in.

“Ensuring that South Africa has a quality affordable health care system is critical. And the bill presents an important opportunity to think systematically about what needs to be done to fix the current health system. But there is still a long way to go.”

 

A Financial Mail report says Motsoaledi struck a discernibly populist tone last week when, with much fanfare, he published draft legislation which paves the way for the NHI.

“It will not be an exaggeration to say that the NHI is the ‘land question’ of health,” he told politicians two days before releasing the bills. “Every citizen‚ to reach their potential in all other aspects of their life‚ needs good-quality‚ equitable health care‚ regardless of who they are. To achieve this‚ equitable and fair financing of health is (necessary).”

The NHI, he vowed, would usher in a “new order” in which a person’s access to health would no longer be contingent on their income. As part of this, sweeping changes were also in the offing to provide much-needed financial relief for medical scheme members.

The report says it was a brave call – not least because he implies that the disaster that is the public health-care system is entirely due to a lack of funding, rather than incompetent and unaccountable leadership. Considering the holes in the two Bills he released last week, the report says, it’s not immediately clear that Motsoaledi has much of a handle on finance either.

In brief, the NHI Bill proposes setting up a central fund to buy health-care services for SA’s entire population, while the Medical Schemes Amendment Bill contains swathes of reforms, most of which have no direct relationship to NHI.

In answering why Motsoaledi released this half-baked legislation, the report says it is helpful to consider the political context. To some extent, he had his back against the wall. As far back as 2007, at the ANC’s policy conference in Polokwane shortly before Jacob Zuma swept to power, the party committed itself to the NHI. But those were different times: GDP for 2006 had hit 5%, and the fighting talk was of it hitting 6%.

Then came 2008. And Zuma.

So Motsoaledi’s task last week was to convince critics that his reforms would improve the nation’s health – without breaking the bank. He did neither.

The report says while he tried to reassure the media that the NHI heralded a more equitable system in which the rich would subsidise the poor, when pressed to explain how these changes would ensure patients are no longer let down by the state, he fudged the issue.

He was equally disingenuous about the contents of the Medical Schemes Amendment Bill, claiming it contained consumer-friendly measures that are not actually in it. And he brushed off questions about what the NHI would cost, saying it was “impossible” to calculate. “It is as difficult as asking Codesa how much democracy will cost the country,” he said.

Does that mean the ANC’s original projection in its 2011 Green Paper, which said the annual cost of NHI in 2025 would be R256bn in 2010 prices, was fictional? The report says those cost projections assumed the economy would grow at 3.5% a year, a far cry from the current Reserve Bank predictions for GDP growth of 1.7% for 2018. Or is the truth that Motsoaledi, who has talked up the NHI since 2009, is now gambling that the policy must be implemented for political reasons, whatever the cost?

The report says nearly a decade ago, the NHI was just one of the 10 key issues he promised to tackle, and he was at pains to assure sceptics that improving the quality of public health care was a vital prerequisite for implementing universal health care. He vowed to: improve public hospitals by getting rid of unqualified managers; revamp dilapidated infrastructure; improve primary health care; and put a proper human resources plan in place.

Little of that came to pass. Now the NHI is apparently being hailed as the cure-all for all that ails the public sector.

Last week’s NHI Bill is only the first piece of enabling legislation for this grand vision. But, the report says, it is terminally vague. For example, it contains provisions to establish a central NHI fund, financed by yet-to-be determined mandatory payments from those who can afford to pay. Apparently, it will bypass provincial health departments to buy services from accredited public and private sector providers, at rates set by a ministerial advisory committee. Similar committees will decide on the benefits, medicines and technology bought by the fund.

Motsoaledi explained it thus: the NHI fund will buy services for the entire population from public and private sector hospitals, doctors, and other professionals who meet the quality threshold set by the office of health standards compliance. Everyone will be registered with the fund, and no-one who is a citizen or permanent resident will pay at the point of care. Patients will have to follow correct “referral pathways” – they can’t go directly to a specialist but will have to be referred by a primary provider, such as a GP.
But critical elements of the plan – who will pay, and how much – are unclear.

In the past, Treasury said it was considering various options to finance the NHI – including hiking payroll taxes or a new surcharge on personal income tax. In other words, taxes on the people who government thinks can afford to subsidise the poor.

The report says while Motsoaledi has consistently said scrapping medical scheme tax credits would generate billions of rands for the NHI, Treasury has adopted a cautious tone, arguing that tax credits play a vital role in ensuring medical scheme cover remains affordable.

Of course, government’s desire to implement universal health care is hard to fault. Barely 16% of the population (8.9m people) belong to a medical scheme, which allows them to access world-class care in the private sector. The other 84% of the population are sentenced to interminable queues and shoddy treatment at the hands of the state unless they can pay for private health care. The NHI’s goal is to ensure everyone has access to affordable and decent health care. The aim, like universal health-care programmes globally, is to finance it in a way that compels the rich to subsidise the poor, the young to subsidise the old, and the healthy to subsidise the sick.

The report says President Cyril Ramaphosa said as much last week, implying that the NHI would be implemented, whether people like it or not. “Our job as the governing alliance, as the ANC, is to make sure all South Africans have access to the best health care. Right now our hospitals are burdened and our health care is in crisis, and we believe the only way to (correct) this is to pool all resources and everyone makes a contribution,” he said.

A recent article in The Economist argued that universal health-care coverage was achieved by some countries when they were relatively poor – including Britain, which introduced the National Health Service in 1948. It points out that several developing countries, including Thailand, have since then implemented universal health care despite their relatively low GDP per capita.

The challenge facing South Africa is how best to use limited financial resources to do so. The report says this is the crux of the issue: many South Africans have lost faith in government’s capacity to deliver services, so convincing them to pay more tax to a system they do not trust is going to be a tall order. Just ask the architects of e-tolls.

The glaring flaw in Ramaphosa’s argument is that the NHI isn’t designed to fix a health-care system that has already collapsed under government stewardship. Public health care is bedevilled by poor leadership of the sort that led to 144 people dying in the Life Esidimeni scandal. But the NHI Bill doesn’t even try to address this.

The report says one reason why Motsoaledi may have rushed through a Bill so short on detail is that, politically, he is under fire from all sides. The chorus from health lobbyists, trade union federation Cosatu, and recently a group of veteran health activists is growing, louder all the time, questioning whether he has what it takes to fix public health. This month, Cosatu asked Ramaphosa to sack Motsoaledi, saying he had “sold out” and “outsourced the NHI to private interests” — a claim it has made for years.

Equally, a sharply worded letter from a group of veteran health activists, convened by Fazel Randera and Billy Ramokgopa, has called for a review of the NHI policy, and intervention from Ramaphosa to fix what they describe as a “perfect storm of ineffectual leadership, poor management and entrenched corruption”.

The report says they have a point. Despite his success in driving what is now the world’s biggest HIV treatment programme, Motsoaledi presides over a chaotic system that lurches from one crisis to the next. KwaZulu-Natal’s desperate shortage of oncologists, and the Life Esidimeni scandal in Gauteng, are just two of the tragic examples that have made headlines. But there are many more silent calamities.

In Limpopo, recent parliamentary hearings revealed, cancer patients at public hospitals wait, on average, for a year before they can get vital radiation therapy. In the Eastern Cape Health Department, medical negligence claims now exceed, by R600m, its entire R23.7bn budget for the 2018-2019 fiscal year. Even the relatively well-managed Western Cape is struggling to find the money to fix slowly decaying state hospitals.

“While the NHI is important, we cannot for a moment allow it to distract us from the very pressing question about the collapse of parts of the health-care system,” says Mark Heywood, executive director of lobby group Section27. “The idea that (NHI) is some sort of panacea for all the pathologies of crisis in the public and private sector just does not stand up (to scrutiny),” he says. Part of the trouble, he says, is that NHI is a long-term project (set for full implementation in 2025) that diverts attention from issues that must be dealt with now.

“There are things that could be done immediately that would lead to drastic improvements. We don’t accept Motsoaledi’s argument that one of his biggest problems is a legal one,” says Heywood, referring to the fact that the constitution says health is a concurrent power, with the different spheres of government sharing responsibility.

The report says Motsoaledi’s argument is that his national department sets policy, which the provinces then implement – and he has no authority to intervene when things unravel. Heywood sees it differently. “We are not a federal state. The minister has to ensure the maintenance of standards, and he has the legal power to step in. He has never done so,” he says. Improving management and leadership in the public sector would go a long way to improving accountability in public health, he says. And contracting with the private sector need not wait for an NHI fund.

The report says Motsoaledi’s sweeping changes to the medical scheme industry, which will affect the 8.9m people in SA who use medical aids to access private health care, are equally problematic. When presenting the Medical Scheme Amendment Bill, he took a strong consumer line, characterising it as an intervention to protect vulnerable members from nefarious medical schemes and brokers.

For a start, he promised to ban co-payments (the amount that medical aid members must pay from their own pockets if the scheme covers only part of their bill); abolish brokers, who he said “are actually not needed”; end waiting periods before someone qualifies for medical aid; and stop schemes sitting on excessive reserves – money that, he said, could be better spent on members’ health-care needs.

Tellingly, the report says: none of those measures is actually contained in the Bill published. True, the bill says co-payments are prohibited for a yet-to-be defined set of “comprehensive service benefits”. But the Medical Schemes Act already prohibits co-payments on prescribed minimum benefits (PMBs), the basic basket of care that schemes are required to provide to all their members.

While patients often do face co-payments for services that aren’t in the PMB basket, the report says they will still do so under Motsoaledi’s new Bill for anything not covered by the comprehensive service benefit package.

The Bill does not ban brokers. It does, however, tighten the definition of brokers and introduces greater transparency about their fees, saying they must be disclosed and agreed to by members. Nor does it change the 25% solvency requirement of the Medical Schemes Act, which requires schemes to keep at least three months’ worth of contribution income in reserve to ensure they can pay all claims in the event of unforeseen circumstances. Motsoaledi said medical schemes were collectively sitting on reserves of R60bn – equivalent to an industry-wide holding of 33% – and characterised it as “unnecessary accumulation at the expense of patients”. “We believe these huge reserves were accumulated partly through high premiums, because we know that for the past 15 years medical scheme premiums have increased faster than consumer price inflation,” he said.

Again, the report says, the argument is flawed. Among the reasons medical costs are rising faster than inflation globally (not just in South Africa) are that people are living longer, medical technology is more expensive, and the rise in noncommunicable diseases, such as diabetes, is leading to greater spending.

The medical schemes industry itself has been calling for a review of the solvency requirement for years. It argues that a larger scheme with a younger membership profile should be required to hold a lower percentage of its income in reserve than a smaller scheme with older members. The Council for Medical Schemes is reviewing this, but this could still take another two years.

The report says the Bill does not scrap waiting periods. It does away with waiting periods for children but continues to allow schemes to impose a three-month waiting period if someone has not been a member of a medical scheme for the past 90 days.

“The Bill is actually much tamer than the minister indicated,” says Percept CEO Shivani Ranchod is quoted in the report as saying. “It talks only very marginally to the NHI Bill, and much of its content has been on the Council for Medical Scheme’s wish list for years,” she says. This includes a set of provisions that beef up medical scheme governance, with tighter rules about their constitutions and the roles of trustees.

However, industry sources are worried about the financial impact of the Bill’s new cross-subsidisation measures. It says contributions for mandatory benefits will be based on income, and people over 30 will pay higher contributions than children and young adult dependants. The risk is that older people, such as pensioners, may end up subsidising younger people and families, which they can ill afford to do.

Mediclinic consultant Roly Buys says in the report that it is hard to gauge the financial impact of the Medical Schemes Amendment Bill, as it contains so many variables. “There are too many moving parts to understand the consequences,” he says. “Is the PMB catastrophic cover going to be retained, or not? Will there be an increase in premiums, and a reduction on what people spend in the economy? There are no answers in the Bill.”

Despite what Motsoaledi has said, the medical scheme Bill is also silent on the notion of a “uniform tariff” for health care. When asked, he offered no more detail on how tariffs would be set, or how much flexibility health-care providers would be given to charge above or below these thresholds.

The report says it is this vagueness and lack of specifics that makes it all seem so rushed. Motsoaledi has also perplexed observers with the timing of the Bill. Many people thought he would wait for the findings of the Competition Commission’s health market inquiry (HMI), which was set up four years ago to probe barriers to competition and care in private health care. While the inquiry is running behind schedule, it is expected to publish an interim report and recommendations soon.

On this point, the National Education, Health & Allied Workers Union (Nehawu) says: “We are concerned that the minister decided to release the Medical Scheme Amendment Bill before the findings of the HMI, as this inquiry was meant to deal with matters that have a direct bearing … (on) the current operations of medical schemes and private hospitals.”

Nehawu expects the inquiry to make recommendations about the market power of the three big private-hospital providers — Mediclinic, Life Healthcare and Netcare — which the trade union believes is driving the rising costs of private health care. As it stands, annual health-care inflation typically exceeds consumer price inflation by several percentage points, threatening the affordability of medical scheme cover.

Clearly, private hospitals are becoming more expensive. The report says figures provided by Motsoaledi show that 45% of medical scheme expenditure in 2016 (R56.6bn) was paid to private hospitals. But in 2002 that figure was just 29.5% – or R10.5bn. In response, private hospitals argue that this escalation is because more people are using their services, rather than because of higher prices. They say their tariff hikes have closely matched inflation.

The report says trade unions have been curiously quiet about Motsoaledi’s plans to ultimately scrap medical scheme subsidies for state employees. Maybe this is because, despite his fighting talk, there is nothing in either Bill that spells out how he plans to do so. These generous perks are costing government dearly: its medical scheme subsidy bill rose 16% between 2015 and 2018, from R26.8bn to R31bn. Of this, R20.5bn went to members of the Government Employees Medical Scheme (Gems), R2.2bn to civil servants who were not on Gems, and R8.3bn to people working for state-owned enterprises.

Government has earmarked another R26bn in 2018 for medical tax rebates and credits, which provide relief to members both within and outside government. Motsoaledi has previously said these subsidies and tax rebates are a potential source of NHI funding. But he barely acknowledges the role they play in keeping medical aid affordable for lower-paid workers, particularly unionised civil servants.

The report says it’s a risky gamble because if those benefits are shaved away too quickly, and people fall out of the medical scheme net before NHI can meet their needs, government is likely to set itself on a collision path with its own workforce. The recent Eskom strike illustrates how this can go badly wrong.

Alex van den Heever, chair of social security systems administration and management studies at the University of the Witwatersrand, says in the report the wording in key parts of both Bills is ambiguous. No-one knows if medical schemes will be prohibited from funding services covered by the NHI (and will thus be relegated to a minor complementary role) or whether people will be able to use medical schemes to substitute for NHI offerings.

But as van den Heever says, this is “likely to be a material issue down the line”. He also warns that the proposed governance structure for the NHI fund will be vulnerable to “state capture” because it vests too much power in the minister. The Bill says the NHI fund will be overseen by an independent board accountable to parliament. But the minister has the power to recommend board members to cabinet, and the power to fire them or dissolve the board.

Raymond Parsons, a professor at North-West University, says government needs to apply some reality tests to NHI. “This includes recognising that the economy is in a low-growth trap, accepting that recent commitments to free higher education have taken centre stage in government spending, and acknowledging that SA’s public finances remain highly vulnerable,” he says.

Parsons says this doesn’t mean NHI isn’t desirable – but to make it happen, there needs to be tough reprioritising of how government spends its money. “A failure to do so will merely add to long-term risks in the fiscal outlook,” he says.

The report says Ramaphosa may have acted quickly to remove key architects of state capture, but he has shown far less willingness to bump heads with the trade unions or rein in those in critical positions within his party. For NHI to be more than pie in the sky, these harder issues will need to be tackled first.

 

Johann Serfontein, a member of the Free Market Foundation healthcare policy unit says that despite Motsoaledi not wanting to commit to even a rough estimate of costs of the NHI scheme, the failure thereof will be funding. He writes in Business Day that this will include the lack of sufficient funding entering the fund and problems with payments from the fund.

Serfontein writes: “The South African economic situation is dire. Policy initiatives that were announced without consulting National Treasury have given South Africa a one percentage point increase in the VAT rate to fund free higher education. Going as far back as the 1970s, 80% of first-year students historically never graduated, so this investment would amount to a R40bn annual loss. Economic growth is at a standstill and unemployment is skyrocketing, with further increases expected due to the implementation of a national minimum wage.

“In this environment it is truly shocking that the most important aspect of the NHI Bill, namely the money available for it, was brushed aside by Motsoaledi as not being his problem.

“The underlying assumption that the 4.4% of GDP currently spent on private healthcare should be available to all citizens is an inaccuracy the minister fails to comprehend. Some R45bn of private spend might be funded by the government in the form of an employer subsidy or tax credits, but this still leaves R140bn spent by medical scheme members on their private healthcare, forsaking other personal comforts in the process. Should this private health expenditure stop tomorrow, the public system will gain an additional 8.8m people to treat, without the state budget increasing by a single cent.

“This private money would leave the health system. It does not magically transfer into the public sector for utilisation. Unions will not allow their members to lose out on R31bn in employment benefits – and they will demand it in cash, leaving only the medical tax credit to possibly be added to the health budget. Even this transfer is not guaranteed in South Africa’s fiscus.

“All indications have been that the service basket and benefit design will be adjusted according to the availability of funds. Medical schemes, in turn, will only be able to pay for complementary services not covered by the NHI Fund. It is widely accepted that only 10% of citizens will be able to afford medical schemes in the NHI system of mandatory pre-payment. The affluent will therefore have comprehensive cover under NHI and continued medical scheme membership, while the other 90% of South Africa’s population will be subjected to structured denial of healthcare, based on available public funding and the limitations imposed on the benefit design.

“NHI will not cover all diseases for everyone. The poor and middle-income citizens will go untreated for any expensive disease not covered in the basic service basket. The current public system covers all diseases, without explicitly excluding any for treatment. This will not be the case with the NHI. It remains to be seen which public facilities will render services in NHI, as an extrapolation of the results of the recent Office of Health Standards Compliance inspection indicates that just 25 out of 3,500 public facilities would currently qualify to contract with the NHI Fund.

“The second major concern is getting reimbursement for services out of the NHI Fund. Currently, the Medical Schemes Act compels medical schemes to pay providers within 30 days of invoice. The NHI draft Bill contains no such time clauses. One can therefore assume it will be administered in a similar fashion to the Compensation Fund, where the average payment takes 78 days. While private general practitioners will be contracted on a capitation basis by the districts, there is no information on how private specialists will be contracted by the NHI Fund.

“Hospital-based diagnosis-related group payments assume that specialists are employed by hospitals, and outside of this there is no indication of payment of private specialists. Provinces will remain responsible for maintenance of facilities, and with medical liability in the state capped at R1m, the costs of rendering services in the state will be substantially lower than in the private sector, where maintenance costs and unlimited medical liability apply.

“The question remains whether NHI tariffs will be based on the state costs of rendering a service. Doctors on the NHI provider network will be kicked off if they charge above NHI rates. If NHI rates do not consider private practice costs, providers will simply cease to render services in South Africa altogether, adding to the shortfall of medical personnel.”

 

Doctors are still coming to grips with Health Minister Dr Aaron Motsoaledi’s universal health care proposal, which promises equal and high-quality health care for rich and poor, says a Cape Argus report. Many doctors are sceptical about the plan, voicing concern over the resources required for it, funding for it and its implementation.

Anaesthetist Dr Milton Raff said many doctors had reservations about their profession being regulated. “Introducing a regulating system that will affect doctors’ money may lead to medical migration,” he said in the report. The idea of the universal fund was appealing, but there was uncertainty over its implementation.

“We can’t help but worry who will fund this – taxpayers? There’s no clear indicator of what will transpire in the next few years. It would be unfortunate to implement something prematurely and end up damaging the system, which is already in need of an upgrade,” he said.

Kenneth Marion, chief operating officer of Bonitas Medical Fund, said: “While in principle we support the government and applaud them for taking proactive measures, there are a number of questions which still need to be answered.

“How will the system ensure quality health care? How will it be administered? Another concern is around the proposal that there be a single public purchaser and financier of health services for the country.”

A gynaecologist and obstetrician in Cape Town, who did not want to be named, said “we can’t be negative when we don’t even know the impact it (NHI) may have”. “There are a lot of poor people who don’t have access to good and affordable health care and that needs to be corrected. Is the NHI really the solution? We don’t know.”

Dr Dumani Kula, deputy CEO of Clinix Health Group, said the objectives of the NHI were to improve access to quality and affordable health care for the entire country, and specifically correct the injustices of the past. “The creation of the NHI fund is an opportunity for the private sector to work closely with government in fulfilling the goal of universal health care.”

The Conversation report
Financial Times report
Business Day report
Cape Argus report


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