Healthcare leaders have said public healthcare funding should not increase at the expense of medical schemes, highlighting the need to clarify ambiguities in the Bill before the implementation of NHI.
The Citizen reports that the Board of Healthcare Funders (BHF) recently held a briefing session with key figures including BHF managing director Dr Katlego Mothudi, BHF chairperson Neo Khauoe, Dr Stan Moloabi, chairperson of the BHF’s Universal Health Coverage Committee, Dr Mvuyisi Mzukwa, chairperson of the South African Medical Association (SAMA), Professor Alex van der Heever, an expert in healthcare governance at Wits, and BHF’s head of health system strengthening, Dr Rajesh Patel.
Khauoe, who supports universal health coverage but strongly opposes the Bill’s approach, said the private health funding sector should not be sacrificed in favour of NHI.
“It is too valuable in terms of jobs, scarce skills, infrastructure, financial investment, the quality of healthcare services beneficiaries receive, the value it adds to the economy and the support it has lent to the public health sector,” she argued.
Patel highlighted concerns about section 33 of the Bill, pointing out the need for clarity in the Minister’s decision-making processes regarding the inclusion of rules for thorough implementation, and the ambiguity in NHI contracting with health service providers.
Additionally, he said maternity care was excluded from the NHI benefits – and nor were there any indicators in this section “to guide the Minister about when NHI is fully implemented.”
“Section 33 is therefore contrary to the constitutional principle of administrative justice and allows the Minister to act arbitrarily,” he said.
“The Minister’s determination is an administrative decision subject to section 33 of the Constitution and the Promotion of Administrative Justice Act and therefore it must be lawful, reasonable and procedurally fair.”
Moloabi said medical schemes were important in healthcare provision and went beyond just financial aspects, while Van der Heever said the Bill would further undermine the already precarious situation of the healthcare sector.
“Medical schemes are an integral component of the system, providing cover for 9m lives. The hybrid universal coverage model is widely employed across the globe. I am concerned about there being a single funder in the NHI Bill and about the pressure on the system should all citizens rely on a single scheme.”
He said a single fund was also an impractical approach for rich as well as developing countries, and given South Africa’s limited GDP strength, such a proposition appeared particularly unreasonable.
Concern about accessibility rates
Khauoe also specifically emphasised the expected discrepancy in healthcare accessibility rates among employees under the NHI Bill, compared with the existing system.
“This is anticipated to extend the duration of employees’ recuperation, resulting in supplementary expenses for employers because of postponed resumption of their staff’s work duties.”
She said considering the democratic nature of South Africa, it was crucial to prioritise the provision of opportunities for citizens to exercise their autonomy in shaping their future.
Khauoe also mentioned the lengthy waiting times for various medical treatments.
“What strategies could be used to help the NHI Bill to simplify some of its processes, if, for example, you are prepared for a specific operation but there is no anaesthesia available and the procedure is not performed on the specified day… what then?”
It was also imperative, she added, to establish a reliable mechanism to guarantee that patients scheduled for operations or procedures would “indeed undergo them on the designated days without any rescheduling”.
“This demonstrates the necessity of both public and private sector involvement in addressing and resolving existing imbalances, as a primary concern.”
Mzukwa said the Bill could impose financial consequences on healthcare practitioners.
Though healthcare providers may qualify for payment for services provided to beneficiaries of the NHI, these rates would be standardised.
“But this could potentially lead to a decrease in their revenue compared with the fees charged in private practice. Therefore, it may be necessary for them to adjust their financial expectations and business strategies.”
Various consequences
He said the potential consequences of NHI could vary significantly, depending on the legislative and regulatory framework in place.
Mothudi said the BHF aimed to “provide the health citizen with a comprehensive understanding of the potential implications, challenges and shortcomings of the NHI Bill”.
“The BHF firmly supports the freedom of people to spend their disposable income as they see fit, including insuring any of their health needs through medical schemes.
“This right is derived from the constitutional value of personal freedom in a democratic society and the rights to human dignity, privacy, freedom of association, freedom of thought, belief and opinion, as well as the right to have access to health care services and emergency medical treatment.
“The NHI Bill is anticipated to have a cascading impact on the already declining state of the public health system in South Africa.”
The Citizen article – Healthcare leaders reiterate NHI Bill concerns (Restricted access)
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