A one-size-fits-all National Health Insurance (NHI) fund would only be palatable if it provided current levels of medical scheme benefits for all – which was extremely desirable, but unfortunately unaffordable, believes Discovery CEO Adrian Gore.
He told Business Day that the proposed NHI fund “is a moral imperative for the country” and he fully supports it, but warned that it would require careful implementation to ensure long-term fiscal sustainability.
The Institute of Race Relations estimated in 2020 that NHI could cost the country R700bn a year when it becomes operational, in 2026 as the government has envisaged.
That compares with SAʼs total health expenditure in 2021/ 2022, which Discovery says reached R523bn, or about 9% of GDP. Of that, Discovery says about 51% was covered by private medical scheme contributions or out-of-pocket expenditure by consumers. However, given that there are only about 9m private medical aid members in SA out of a population of 60.14m, most citizens rely on state health care.
Gore says Discovery presented what it believes is a workable model for a sustainable NHI to the parliamentary portfolio committee on health proposing an incremental blended funding model that could achieve universal health coverage in a pragmatic and sustainable way. Through this blended model, the NHI fund would be supported by tax-derived funding and also receive a mandatory contribution from citizens who could afford it.
The Discovery model would not permit private medical scheme members to opt out of funding the NHI, but would allow them to buy additional cover if they wished. Gore says this would leave consumers with some degree of choice, while improving overall healthcare access for all South Africans.
“There is significant risk in limiting medical schemes to offering cover only for services not reimbursable by the NHI [as set out in section 33 of the proposed NHI Bill],” said Gore. “The reality is that employed people currently utilising the private sector via medical aid schemes would only be satisfied if the NHI could deliver care that they would expect relative to what they currently receive.”
“The country does have the capabilities and resources to work towards universal coverage, but this will require time and excellent leadership,” he added.
See more from MedicalBrief archives:
Discovery Health outlines its ‘unequivocal’ position on NHI
Gore: NHI won’t shift Discovery’s focus overseas
Discovery offers to partner with government on NHI
Submissions: NHI Bill has serious constitutional and human rights implications