The Hospital Association of SA (Hasa) has predicted a massive 50% rise in spending on people reliant on public healthcare, and called for the revival of healthcare reforms, like compulsory medical aid membership, that were mothballed when the ANC embarked on its NHI plans.
It said this could dramatically reduce the number of patients depending on government facilities, and improve everyone’s access to healthcare.
Initially, and before the ANC’s 2007 resolution on NHI, the National Department of Health (NDoH) had planned to introduce compulsory medical aid membership for everyone in formal employment – and their dependants – along with a risk equalisation fund, to level the playing field between schemes.
If similar plans were brought into play today, this mandatory membership could triple the size of the medical scheme market from 9.2m to 27.5m beneficiaries and slash the number of people dependent on the state from 53.8m people to 35.5m, according to Hasa.
The analysis assumes a dependency ratio of 2.4, reports Business Day.
“We have done a lot of research on this and hope we can collaborate and co-operate with the government to take it forward,” said Netcare CEO Richard Friedland, and the approach “would not cripple the economy”, he added shortly after presenting the research at Hasa’s annual conference.
He told delegates there were were legitimate concerns about the feasibility of the reforms proposed in the NHI Act, and that the scheme would take far too long to implement.
Introducing compulsory medical scheme membership for people in formal employment would improve access to healthcare services for both public and private sector users in the near term, and bring more young and healthy lives into the system, reducing the cost of monthly premiums by 25%-30%.
Reducing the number of people dependent on the government would increase annual public health per capita spending by 52%, from R5 054 to R7 659, alleviate the strain on public hospitals and clinics, shorten waiting lists, and free up money to hire more staff and improve infrastructure.
Friedland said the scheme could be implemented in three phases, starting with people who are formally employed and earning above the tax threshold. This would increase medical scheme coverage from 9.2m beneficiaries to 15.4m. Public sector per capita spending would increase by 12.9%.
Phase two would include formally employed people earning below the tax threshold, boosting medical scheme coverage to 27.5m lives and expanding public sector per capital spending by 52%.
Phase three, which assumes a recovery of the economy and the creation of more jobs, would see ongoing benefits to public expenditure: for every 1m formal jobs created, the public health system would see a reduction of about 2.4m people.
Compulsory health insurance schemes were a feature in many countries, said Friedland. Mandatory contribution schemes for civil servants had been implemented in 61% of the countries in Africa, while Thailand and many other Asian countries had started with mandatory cover for the formal sector before expanding to the non-formal sector.
Friedland also appealed for greater collaboration between the public and private sectors to train healthcare personnel, and to reduce state sector waiting lists for oncology and elective surgery.
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