Government has so far failed to respond to proposals by the Universal Healthcare Access Coalition (UHAC) for healthcare reform before the National Health Insurance (NHI) comes into effect.
The UHAC has proposed a 'practical, evidence-based framework for what it sees as implementable healthcare reform. Its recommendations outline a raft of suggestions for smooth implementation of the NHI – that President Cyril Ramaphosa said last week would proceed this year – and also the quality of public healthcare while controlling the spiralling cost of medical aid schemes, it said.
The structural reforms would also be faster and less costly to implement than the NHI, which UHAC describes as “unworkable” and at risk of massive failure.
While the NHI is expected to take at least a decade to implement, and there is no plan to fund it, the coalition said its framework would make an enormous difference in three to five years, reports TimesLIVE.
UHAC includes 18 specialist medical professional organisations, the SA Medical Association (SAMA), the Progressive Health Forum, and several other associations.
Professor Alex van den Heever, chair of social security at the Wits School of Governance, who researched and compiled the proposals, said: “This is the health system talking to the government; at some point, government will have to listen. So, we are making sure there is a well-developed and deepened framework that will become the point of departure for any adult discussion within society on health reform. It doesn’t mean the government must accept everything proposed at once, but these …are in the public interest.”
UHAC said the reforms were evidence-based and could be designed to work with the country’s tight finances instead of raising taxes.
Steering committee member and convener of the Progressive Health Forum Dr Aslam Dasoo said national healthcare would continue to crumble while the government tries to figure out how to fund and implement an “unworkable NHI”.s.
UHAC proposes free services for income-compromised households while improving service quality in the public sector, and that medical scheme benefits should be covered without co-payments, he said.
Weak governance
UHAC also highlights governance of the politically influenced healthcare system, leading to weak leadership structures due to wrong appointments.
The NHI proposal suggests no change, as it proposes a centralised government with political appointments in key leadership roles.
UHAC steering committee member and chair of SAMA Dr Mvuyisi Mzukwa told BusinessLIVE the NHI Act was not universal healthcare but a vehicle to reach that goal.
However, it could not get there because of the challenges outlined.
“There is confusion, and the perception, even by the Minister of Health, that if one doesn’t want the NHI then they don’t want universal health coverage proposed by the NHI. Not true. We do want universal health coverage but (want to) make sure what is being proposed takes us there.”
Mzukwa called the Act “deeply flawed” as it did not resolve fundamental problems and weaknesses in the system, while Dasoo said as health professionals, they had seen how the health system had deteriorated and hoped the proposals would be considered.
“This plan synthesises all the concerns raised. It’s ready to go and the government can plug and play. We assumed when we went to the President that this was enabled, but the response from him and the Health Minister was unhelpful.
“There is no other plan that works for the system.”
Submissions
Dasoo said the proposals had been drawn up after a meeting between Ramaphosa and Business Unity SA (BUSA) last September, where the President invited submissions.
However, Ramaphosa passed the UHAC submission on to the Department of Health, which replied that it could not engage on the NHI as it was the subject of litigation in court.
The coalition’s proposed intervention starts by recognising that a 100% tax-funded health system is impossible in any future fiscal scenario, but its reforms would enable universal healthcare access for everyone, regardless of their ability to pay for it.
Importantly, it would not require dismantling the provincial health system or creating a single, centralised fund that would buy health services for everyone, as envisaged by the NHI.
The elements of reform in the private sector include:
• Compulsory medical insurance for higher-income groups;
• A risk equalisation fund for medical schemes so that risk is pooled and shared across the population, regardless of healthcare status. This will remove inter-scheme competition and incentivise cost and quality of coverage;
• A social reinsurer for medical schemes to cover low-frequency, high-cost events that may occur. This will spread the risk of these types of events among schemes and members; and
• Regulation to ensure coverage, take account of market failures, and set tariffs.
In the public sector, governance and institutional arrangements that will create accountability are at the heart of the reforms. They include:
• Decentralising governance to district health authorities and hospitals, which independent supervisory boards would oversee. This would ensure local accountability and prevent political appointments. It would also allow hospitals to be autonomous and keep the revenue they collect;
• Governance frameworks that allow for integration between public services and private services;
• Reforms to the recruitment and training of healthcare professionals; and
• Targeted subsidies for low-income groups.
The UHAC warned against attempts to “tweak” the NHI to make it more palatable without fully considering whether the model can work.
See more from MedicalBrief archives:
Will Cabinet lekgotla pave way for NHI compromise?
ANC compromise on NHI not on the cards, says Motsoaledi