Doctors have lodged a last-ditch effort to stop the passing of the National Health Insurance Bill, which has been given the green light by the National Assembly and is now headed for its final parliamentary passage at the National Council of Provinces (NCOP), writes MedicalBrief.
The South African Medical Association (Sama), representing more than 12 000 doctors, has submitted a petition signed by more than 56 000 people to the NCOP, appealing for it to vote against the passing of the NHI Bill in its current form.
In a letter to NCOP chairperson Amos Masondo, Sama chairperson Dr Mvuyisi Mzukwa said they had made written and verbal representations to Parliament outlining concerns regarding the Bill and its potential implications, but these had largely been disregarded.
“Thereafter, we elected to exercise our constitutional right to petition the National Council of Provinces as a last resort,” he said.
Apart from its thousands of signatures, the petition also has 2 000 comments from the public, reports News24.
Sama’s key concerns include corruption risks; the focus on a funding model without tackling human resource shortages and infrastructure issues in the public healthcare system; a lack of cost assessment, and limitations on medical aid schemes.
Mzukwa pleaded with Masondo to take a different stance on the Bill.
“As the final house of Parliament that will decide on the adoption of the Bill before it is signed into law, we implore the National Council of Provinces to consider the concerns raised,” he said.
“We have been ignored since the discussions on the green paper, and despite making submissions, there has never been any consultation or feedback.”
The doctors' appeal comes as Health Minister Joe Phaahla this week confirmed that should the Bill, in its current form, be passed, affordable low-cost medical aid plans, along with traditional medical aid schemes, would be scrapped.
Clause 33 of the current NHI Bill, which is before the National Council of Provinces, already states that medical schemes will only play a complementary role under the NHI.
Phaahla said there was no intention for low-cost benefit options (LCBO) to be integrated into the NHI environment, a News24 report says.
This emerged in Phaahla's response to a written parliamentary question from the EFF's Khanya Ceza.
"It must be noted that there is no intention for LCBO to be integrated into the NHI environment. Instead, the intention is to create an integrated health financing system that prioritises the health of all South Africans through ensuring access to a comprehensive set of personal health services.
"Within such a system, medical schemes would only play a complementary role, as suggested in Clause 33 of the NHI Bill …," Phaahla said.
The demand for these cheaper options has been growing, and the number of people covered by medical schemes in SA has remained stagnant for the past decade.
The percentage of people covered by medical schemes has decreased from 16% in 2000 to 14.86% in 2021.
The Council for Medical Schemes (CMS) has been reviewing the LBCO guidelines since 2015 and, according to the medical schemes representative body, the Board of Health Funders, the regulator has refused to grant its exemptions to continue selling these products since 2016.
In December 2019, the CMS announced plans to disallow LCBO altogether by the end of March 2021.
As the medical schemes industry has been waiting for the guidelines and is unable to sell these cheaper options, insurers have swooped in to launch similar products to cater for the millions of South African consumers who cannot afford medical aid.
Outside of medical schemes, retailers and banks, including Dis-Chem and TymeBank, also sell medical insurance.
These insurance products usually include GP visits, basic blood tests, basic radiology and sometimes hospital cash-back benefits too.
According to Phaahla, the CMS is at the tail-end of thoroughly evaluating all comments, so as to finalise the LCBO guidelines and recommendations.
Michael Willie, CMS executive manager for research policy and monitoring, said in a March (2023) circular that the CMS needs to ensure all inputs received from stakeholders and interested parties are accommodated and considered prior to finalising the LCBO guidelines.
The CMS supports the process to have synergy with other policy developments, such as the current PMB (prescribed minimum benefits) review process (focusing on the PHC package) and broader health system priority programmes, such as NHI," he said.
The NHI Bill was preceded by two policy documents: a green paper published in August 2011 and a white paper published in December 2015, reports Business Day.
However, the public consultation processes undertaken by the government and Parliament to date had been mere tick-box exercises, Mzukwa said, adding that opposition to the Bill went beyond healthcare workers, as evidenced by the signatories to the petition.
“It is also communities. People don’t trust the government.”
The government’s poor track record in service delivery has left communities sceptical about its assurances that NHI will provide better healthcare.
“I was born in Flagstaff in the Eastern Cape. In my village there is still no water; it was promised in 1994. Now the government tells them it will give them a healthcare service under NHI. Yet there is not even a clinic. Communities there say there is no truth to this thing,” Mzukwa said.
The DA has echoed a call for support for the petition, urging all medical professionals, stakeholders and South Africans to sign the document, and begging the NCOP to “truly scrutinise” the document – heed all concerns, and reject the Bill.
Michele Clarke, DA Shadow Minister of Health, said the consequences of policymakers ignoring the grievances of health professionals and experts “will be perilous and certainly not encourage them to invest their skills in a country that refuses to take them seriously”.
While the party believes universal health care and coverage should be pursued, the NHI Bill is not the correct mechanism, she wrote in PoliticsWeb.
“Like SAMA, our objections include the lack of a feasible funding model, human and other resource scarcities – which will surely be exacerbated by the inevitable brain drain as soon as the NHI is implemented – unsafe and improper facilities and equipment, maladministration, corruption and lack of consequence management.”
The exodus would exacerbate the shortage of medical professionals already hobbling the public health sector…the workload on the remaining personnel would increase, with increased risk of burnouts and potentially even more medical errors – medico-legal claims are already swallowing large portions of the provincial budgets, she added.
“It is possible that rural and already underserved areas would be disproportionally affected by the mass emigration, which might also affect medical education and training programmes, as fewer specialists would be available to mentor and teach students.”
News24 article – SA doctors 'implore' NCOP to reject NHI Bill in current form (Restricted access)
News24 – Cheap medical insurance won't be integrated into 'NHI environment' – Phaahla
PoliticsWeb article – DA supports SAMA’s fight against NHI – Michele Clarke (Open access)
See more from MedicalBrief archives:
Low-cost schemes will soften NHI tax burden, argue medical schemes
More NHI appointments approved
Medicare boss warns of skills migration when NHI rolls out
Minister’s powers in NHI ‘unconstitutional’