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Medical schemes' NHI transition will take 'years to decades' – Crisp

The Treasury has approved R30m of this financial year’s National Health Insurance scheme budget for the salaries of 44 technical positions for the NHI, said Nicholas Crisp, the Health Department’s deputy director-general.

The positions are for economists, public health medicines specialists, actuaries and lawyers, based at the Health Department’s head office in Tshwane, he said, adding that it could take months to sift through applications, “and only half of the positions would be permanent – the rest will be on contract”.

At the Hospital Association of South Africa’s (HASA’S) annual conference last week, Crisp said the NHI could take decades to be implemented at full scale. “In the transitional period, which could be many years, we need medical aids to continue to provide coverage and purchase health services on behalf of those who are their members. But the question is: do we need almost 80 medical aids with 250 plus different packages as we currently have?”

According to the NHI head, “there won’t be an instruction in the short term that all medical aids should terminate”. “During times of economic hardship, as right now, we probably need to go slower, so I can tell you that we’re moving in terms of years to decades, rather than months to years,” he said.

Medical schemes would, at some stage during the transitional period, be required to align their basic benefits with those of the NHI, he added.

However, reports Mia Malan, writing for Bhekisisa, at the HASA conference, Barry Childs, an actuary who serves on the NHI and COVID-19 subcommittees of the Actuarial Society of South Africa, warned that while the NHI is not a new concept in SA and has been contemplated for decades, commissions and task teams, such as the 2005 ministerial task team on social health insurance, have raised concerns about the affordability of such a scheme throughout.

Childs cautioned: “High levels of unemployment are seen as a barrier to NHI implementation. So while that task team concluded that an NHI would be the most equitable form of healthcare, it is also the most costly and unaffordable in the medium term.”

Crisp added that more positions will become available in the 2023/2024 financial year, taking the NHI’s technical and administrative staff up to a total of 132.

The NHI, for which membership will be compulsory, will create a single fund used by the government to buy healthcare services at set fees from accredited public and private health providers.

Funds will be collected through a combination of taxes, reallocating medical scheme tax credits paid to private medical schemes, as well as provincial health budgets, to the NHI fund. Payroll tax by employers and employees (collected by employers in a similar manner to unemployment fund insurance contributions), may also be implemented.

If the current version of the NHI Bill, which was published in July 2019, is passed by Parliament, private medical aids will eventually cease to exist in their present form, as they won’t be allowed to provide cover for the services covered by the NHI.

The 44 NHI positions will be spread among five directorates – user and service provider management; healthcare benefits and provider payment design; health product procurement; health systems digital information; and fraud management – each led by a chief director.

Crisp says the Health Department will advertise the positions in the coming weeks – possibly in mid-August – but it could take months to sift through candidates.

“We hope to have at least some of the posts filled by the start of the 2023 calendar year and the rest by February and March,” he said.

Because the NHI Bill is not an Act yet, and therefore not law, only half of the positions, designed for functions that the Health Department would need regardless of whether the NHI is implemented, will be permanent – the other posts will be five-year contracts.

“If the Bill doesn’t become law, and staff who were, for instance, appointed to design the package of benefits that the NHI will offer, those employees will be qualified to do other things for the remainder of their contract period,” said Crisp.

The NHI Bill has been widely criticised for giving the Health Minister too much power to make decisions about appointments and management of board members, opening up loopholes for corruption.

The Bill says the board will have a maximum of 11 members, appointed by the Minister, on the basis of the recommendations by an advisory panel, also appointed by the Minister. Moreover, the board reports directly to the Health Minister — as opposed to Parliament — and the Minister has the power to remove board members if they, in the Minister’s opinion, fail to perform their functions. The Health Minister can also dissolve the entire board under certain conditions.

In addition to concerns about the ability of the country’s already overburdened and short-staffed public health facilities to provide quality services to patients, the NHI Bill has been slated for not specifying what the package of health benefits offered by the NHI will comprise, or how much it will cost to implement the scheme.

Crisp said: “We haven’t been able to inform people what benefits the scheme will offer because we haven’t had positions in place to appoint people who can design those benefits. We can’t even do the business structure. So it’s a catch 22: What do you do first, appoint people to do that with available funds, or wait for the Bill to become law without knowing what those benefits will be?”

The Bill says the NHI will be implemented in two phases with the second and last phase starting this year and ending in 2026. But the COVID-19 pandemic set this process back significantly and it’s highly unlikely that the NHI will be up and running by 2026. For the Bill to be implemented several other Acts, such as the Medical Schemes Act of 1998, will also have to be amended.

 

Bhekisisa article – 44 experts to design details of NHI scheme from January 2023 (Republished under Creative Commons Licence)

 

See more from MedicalBrief archives:

 

NHI a case of ‘multiple impossibilities’

 

Tussle over medical schemes’ role could undermine NHI roll-out – NGO research

 

NHI to be introduced ‘incrementally’ – Phaahla

 

Political battle lines drawn as NHI Bill deliberations start

 

 

 

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