In an attempt to offer better services to all, the South African government is planning to implement a National Health Insurance plan.
With great excitement the Minister of Health, Aaron Motsoaledi, presented two bills for public comment on June 21, 2018. If enacted into legislation, the National Health Insurance (NHI) Bill and the Medical Aid Schemes Amendment Bill will lead to massive changes in the way public health and medical aid coverage are handled in the country.
The government plans to fully implement the NHI by 2025. It will be mandatory for every citizen to belong to the NHI and all state medical schemes will be made redundant. It is still unclear how the NHI will affect private medical schemes and ordinary citizens, and I am sure many of you will wonder about this. What is the NHI and how will it affect us? Some of us are privileged to be employed and can afford medical aid.
The Director-General of the Department of Health, Precious Matsoso, says the White Paper explaining the Bills stipulates that, until the NHI is fully implemented and mature, the role of medical schemes will not change. However, she notes that this doesn’t preclude any changes to the business of medical schemes or transformation required in medical schemes.
“Currently, the role of medical schemes under the fully matured the NHI is that of complementary services cover. This means that only services not covered by the NHI can be offered as cover. If medical schemes undergo both voluntary and regulatory reform to become aligned and consistent with the objectives of the NHI, there will be a need to relook at this,” she says.
This sounds fine, as there is still time to consider my own options, but what of the multitudes who are not as privileged? The Department of Health says that only 8,8 million people belong to medical schemes (out of a population of about 55,5 million). A vast number of people rely on the public health service.
Where will these people get quality healthcare? The right to health is gazetted in Section 27 and subsection 1(a) of the South African Constitution. The White Paper states: “NHI is a health-financing system that is designed to pool funds and actively purchase services with these funds to provide universal access to quality, affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status.
“NHI will be implemented through the creation of a single fund that is publicly financed and publicly administered.”
The NHI will be financed by the NHI Fund established by legislation. The Fund revenue will come from general taxes, payroll and surcharge taxes. The Fund, in consultation with the Minister of Health, will determine pricing and reimbursement mechanisms.
Healthcare providers wanting to contract with the Fund will have to comply with these mechanisms. Will businesses that currently profit from health-services delivery comply? I doubt they will do it voluntarily. Surely this will have serious cost implications for the country.
Martin van Staden, a legal researcher at the Free Market Foundation, says: “With the 2010 cost estimation inflated with the Consumer Price Index in 2017 terms, the NHI will cost the taxpayer R368,8 billion by 2025. Even this, however, is a conservative estimate in light of overly generous future growth estimates provided by the government. Furthermore, in 2017 terms, the NHI will cost South Africa R156 billion every year from 2025 onwards – assuming we achieve two percent growth – which is roughly equal to four 2010 Soccer World Cup tournaments, or 1,4 million government houses a year. The NHI would double South Africa’s health budget.”
Who will pay for it? The essence of the NHI is that the “rich will subsidise the poor, the young will subsidise the old, and the healthy must subsidise the sick”.
Motsoaledi notes: “At present, the poor subsidise the rich.” Will everyone agree with this view? What about the long queues at clinics and overcrowded waiting rooms at public hospitals?
How will the system work? According to City Press, patients will go to NHI-accredited doctors and the Fund will pay those doctors, in the same way as private medical aids currently do. The wide-ranging changes to the healthcare system are supposed to do away with the system currently in place to provide universal, quality healthcare for all.
Instead, analysts say that doctors will be negatively affected. In a country with already too few doctors, it is a situation we can’t afford. According to the Sunday Times, doctors and hospitals that refuse to comply with the new capped fees will not be accredited by the NHI. Rapport stated on June 24, 2018 that about 3 000 doctors who are members of the South African Private Practitioners Forum (SAPPF) will simply refuse to take part.
As far back as April 2013, the SAPPF warned that the NHI will not work.
Some countries have, however, successfully implemented similar health insurance packages sponsored by their governments. In Switzerland, there are no free state-provided health services. Instead, private health insurance, regulated by Swiss federal law, is compulsory.
The government subsidises healthcare for the poor on a graded basis, with the goal of preventing individuals from spending more than ten percent of their income on healthcare. In Singapore, the government controls and heavily subsidises healthcare – however, with the criterion that no medical service is provided for free. Hospitals are overwhelmingly public, with a large portion of doctors working directly for the state and citizens contributing to a national insurance plan known as MediSave. With this plan, each citizen accumulates funds that are individually tracked, and these can be pooled within and across an extended family.
Most Singapore citizens have substantial savings in this scheme. In 2014, Bloomberg ranked the health-care system in Singapore as the most efficient in the world. Armed with this information, can we prepare ourselves for a shake-up in the health sector? Especially in the current economic climate with an ever-increasing cost of living?
Let’s hope the NHI addresses the ailing healthcare system, and that it will be accepted by all and will benefit everyone equally – as it is supposed to be.
Raven Benny is the chairperson of QASA. He has been a C5, 6 and 7 quadriplegic since 2000. He is married with five children, is mad about wheelchair rugby and represented South Africa in 2003 and 2005. He also plays for Maties. email: rbenny@pgwc.gov.za
