NHI: Leave it to me, Ramaphosa tells SA’s healthcare leaders

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President Cyril Ramaphosa has told helalthcare industry leaders that  he would personally be overseeing the implementation of the National Health Insurance scheme and that it could and would succeed, writes MedicalBrief.

All South Africans will be covered by the National Health Insurance (NHI) by 2025, which will begin in a phased approach from 2019, Fin24 reports President Cyril Ramaphosa told healthcare sector representatives last week. He urged health professionals and the industry meeting at the Council for Scientific and Industrial Research in Pretoria to see universal health coverage as an investment and not a consumptive expense.

The report says Ramaphosa’s consultations with the healthcare industry come as the public and interested parties have until various dates in September to comment on three key pieces of legislation set to shake up the healthcare sector – the NHI Bill and the Medical Schemes Amendment Bill both released in June; and the Health Market Inquiry preliminary report, published in July.

Ramaphosa said he would like to emerge from the meeting having gained consensus on a number of issues, ahead of a health summit to be held at an unspecified date.

The report says there has been concerns about the affordability of the NHI, with the Davis Tax Committee in March 2017 finding that according to its scenario planning a 4% increase in payroll tax and a 3% increase to the value added tax (VAT) rate would be needed to fund universal health coverage. But Ramaphosa said that an NHI will bring down costs as there will be economies of scale on medicine and equipment.

The report says he praised the public health system which he said had done a lot to improve life expectancy and reduce HIV infections since democracy. But the president said he is concerned about staff and medical equipment shortages in public facilities and the uneven access to healthcare by higher income and lower income households. “We must accept the reality that the quality of service cannot be improved by a fatigued and demoralised workforce,” Ramaphosa said.

He pointed to Scandinavian countries such as Norway and Sweden which introduced universal healthcare saying they saw this as an investment in the health of their workforce and population. “I am determined that this matter should be addressed so that we should be defined as a country that cares for the people who are most vulnerable when they are sick,” Ramaphosa promised.

The report says the meeting was closed to the media shortly after Ramaphosa’s address to allow the industry to hold a frank conversation with the president.

 

Ramaphosa believes that the proposed NHI Bill can and will be a success, as it will provide “good quality health care” for all, irrespective of their background, race or creed. “Everyone should have access to healthcare based on need, and not money. When it comes to health, there should be no differentiation,” Ramaphosa is quoted in News24 as saying. “I am convinced that our approach to health needs to be seen as an investment because, when our people are healthy, they become productive,” Ramaphosa said.

The report says government has been working on policy and programmes to achieve universal health coverage through the NHI for close to a decade. “NHI will ensure that all our people, whether you are black or white, rich or poor, you will be able to access a comprehensive range of health care services,” he said.

Ramaphosa, however, also acknowledged how the shortage of professionals had compromised the health sector. A report by the Office of the Health Standards Compliance (OHSC), tabled in Parliament, stated that health facilities which were inspected, on average, met less than 50% of the required standards. This prompted Ramphosa to urge stakeholders to discuss the severe shortage of professionals within the health sector.

Ramaphosa said he hoped that South Africa’s healthcare system would become one of the best among the world. “The provision of quality healthcare is in our hands. We are the key factors to make this happen,” he concluded.

 

Ramaphosa has put the NHI scheme at the top of his list of priorities and his office will be taking the reins of NHI, reports Business Times. ‘Leadership is what matters, and that is why I have decided that I am going to, from the President’s office . . . provide leadership on NHI . . . We are going to lead it and we are going to be talking about it all the time because it is important (and) in my view, it is achievable,’ Ramaphosa said.

The plan is to implement NHI incrementally from next year, he said. Full implementation has previously been earmarked for 2026.

For decades South Africa has had what Ramaphosa described as a ‘two-tiered’ health-care system where most of the country’s population, which lives in poverty, only has access to public health care, which is characterised by poor infrastructure, a lack of facilities and a skills shortage. The private sector, on the other hand, offers those with more money access to high-quality care. “We must put behind us the era of quality health care being the exclusive reserve for those with deep pockets,” he is quoted in the report as saying. Ramaphosa said NHI would be a success but not without all the role players focusing their minds and resources.

The report says asked about the president taking control of his flagship project, health minister Aaron Motsoaledi said he had requested Ramaphosa’s involvement in NHI to give it the priority it deserves. “Universal health coverage has become a global movement similar to the right to access to ARVs by people living with HIV and Aids,” said Motsoaledi.

As part of its work towards implementing NHI, the government, the private sector and NGOs have put together the Draft National Quality Improvement Plan, aimed at ensuring that the public health-care sector meets quality standards. Jacqui Stewart, CEO of the Council for Health Service Accreditation of Southern Africa, who presented the plan to the meeting, said in the report that it was meant to pull together work being done by NGOs and the private sector to ensure that there is faster compliance and quality from health-care facilities.

The NHI Bill has set out two processes to determine the suitability of health-care providers to provide services under NHI. The first is certification by the OHSC and the second is accreditation by the NHI Fund.

“The OHSC tried to certify all the hospitals against the regulated standards but what they are finding is that the facilities aren’t getting up to speed as quickly as they can. Our concern is that if we wait for that to happen, we are losing ground for getting sustained quality for NHI,” Stewart said. Part of the proposal includes using facilities which are soon to be identified as centres of excellence as test cases for NHI accreditation. This means that facilities that have been doing well in terms of staff skills, quality of services and infrastructure will assist those not meeting the standards.

According to the report, the Board of Healthcare Funders of Southern Africa (BHF), which represents medical schemes, administrator and managed care organisations, said it supported the plan, which it was also involved in drafting. BHF head of benefit and risk Dr Rajesh Patel said the plan was in response to calls for the public sector to be fixed. “This (plan) is an intention to move in that direction and I am sure a lot will probably be done by the (OHSC),” he said.

Mark Peach, executive head of public affairs at the Hospital Association of SA, said in the report that the association supported all the steps that were being taken to improve the performance of the health-care system. “We welcome the leadership shown by the president for demonstrating the importance to him and the country of finding solutions to the many health-care challenges we face so all South Africans enjoy an effective and efficient health-care system. We are committed to working with him and the national department of health to form effective legislation … and action plans,” Peach said.

 

Trade union Solidarity believes, meanwhile, that the power of medical services in South Africa will be negatively impacted if government decides to centralise the heathcare system through the NHI Bill. Engineering News reports that speaking at a Healthcare Crisis Summit organised by Solidarity, CEO Dirk Hermann stressed that a decentralised approach with proper government structures in place was needed to sustain the NHI.

“We know by looking at state-owned entities (SOEs) in crisis such as South African Airways, Denel and Eskom, that government does not have the capacity to manage large SOEs.” He noted that the NHI programme would be the largest SOE in government, and that implementation of the programme would cost R357bn, the bulk of which would be carried by middle-class taxpayers.

“If government wants to finance the system using VAT, then it means that VAT must be doubled. We can’t afford for this to collapse because it will directly affect South Africa’s economy,” he said.

He further noted that the country currently had an effective private medical system that needed to be supported by proper legislation and regulation to function even better. “The more we empower the private sector and the more access we give ordinary South Africans to that sector, the more government can focus on an effective public system, ” he said.

The report says also speaking at the summit, chair Flip Buys said that, since being introduced in July, the proposed NHI Bill has evoked much concern among practitioners, economists and the general public about the future of healthcare in South Africa. He noted that state interference would lead to increased medical costs, poorer service and more ill people in South Africa.

He further stated that this would be caused by over-regulation, which increases costs; price determination which distorts the market for medication; chemists closing their doors and preventing a free market system; limitations on the development of more hospitals, which creates superficial deficits that, in turn, increase costs; and regulations which prevent the training of more doctors and specialists, resulting in more deficits and increased costs.

“It is, therefore, extremely important that we use this time to influence the policy,” he is quoted in the report as saying.

 

Fin24 report
News24 report
The Times report (subscription needed)
Engineering News report


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