“There has been huge opposition against the introduction of the NHI. I can say we are going to proceed… it will go ahead,” Ramaphosa said.
The private healthcare industry is concerned after President Cyril Ramaphosa recently said the NHI Bill is destined for enactment, a fait accompli that leaves no room for dissent, at the ANC’s 112th-anniversary rally.
The National Health Insurance (NHI) Bill has already been approved by the portfolio committee for health, parliament and the National Council of Provinces and just needs Ramaphosa’s signature before it comes into effect. No changes were made after various organisations and individuals made submissions.
Craig Comrie, chairperson of the Health Funders Association (HFA), warns that should the current version of the NHI Bill be signed into law, citizens face a stark reality: a healthcare system tied to the bureaucracy of unfriendly processes to access care listed as NHI services.
“This process is devoid of choices of where and how to access healthcare and will be the biggest compromise for a healthcare consumer who has no alternative care and is effectively tethering their fate to the state’s monolithic single-funder structure.”
The profound seismic shift in the current version of the NHI Bill
He says the current version of the NHI Bill would signal a profound seismic shift in the very fabric of South Africa’s healthcare dynamics.
“Exactly how this will work in practice appears deliberately unclear, with crucial details around funding and the list of services that will be available in the NHI is not yet defined, nor budgeted for.”
Quality healthcare should be available to everyone, irrespective of the capacity to pay for it, Comrie says. “There is more than one path to Universal Health Coverage (UHC) and there are quicker and more effective ways than the NHI Bill to bring our current two-tiered health system into closer alignment with its stated objectives.”
He says it is possible to work towards the aims of universal health care while protecting and building South Africa’s health assets and protecting constitutional rights.
Comrie warns that as the NHI Bill stands, any procedure or service listed covered by the NHI cannot be paid for privately or with medical scheme cover.
“This means that everyone will be at the mercy of a single state funding system for these services and it greatly diminishes the right to freedom of choice in how and where a person can access healthcare in South Africa.”
Consider that under the proposed NHI model, patients requiring standard procedures, such as tonsillectomies and hip and knee replacements, would have no option but to live in discomfort until their turn comes up on the NHI’s waiting lists, Comrie says.
Universal health care in other countries
“If we look at the UK’s comparatively well-funded National Health Service (NHS), which has been held up as a model for South Africa’s NHI, procedures such as these typically have significant waiting lists often longer than a year, while patients receive ongoing pain management treatment.
“Then again, UK patients still retain the right to go the private route to access life-enhancing procedures sooner outside the public health system. Many other European countries struggle with the same issue of growing costs and where national budgets are unable to keep up, queuing becomes a national pastime.”
At this juncture, Comrie says, it is worth pointing out that the UK’s gross domestic product (GDP) per capita to support the NHS is $46 510 compared to South Africa’s mere $7 055. The public health system of Denmark, which has a GDP per capita of some $ 68,007, is another country that has been held as an example of what South Africa’s NHI aspires to achieve.
“We have to be realistic about how we get closer to universal health coverage as a society and we cannot afford to put all our eggs in one untested basket and hope for the best. Bringing the public health system closer to the private system to improve access to quality healthcare for everyone while maintaining the option for additional funding mechanisms would advance the aims of UHC more speedily. “
The role of medical schemes
Medical schemes are non-profit funds established to fund private healthcare and remove the pressure on public health services, thereby reducing queues and government funding. Currently, people who belong to medical schemes remove the obligation from the state to fund their healthcare needs, while still contributing tax to sustain public health services, he says.
“Nationalising healthcare funding as proposed under the NHI Bill is a risky step, as removing private funding diminishes opportunities for the retention of specialist skills, general infrastructure investment and the development and long-term management of health resources.”
Comrie points out that alternative models have been discussed that would allow the improvement of public health facilities with combined public and private funding and proposals of partnerships to improve the quality of the public health system while reducing costs to those with medical scheme membership.
“A single, centralised funder model is not essential for speeding up progress towards the goals of UHC. It is possible to get there without incurring the constitutional pitfalls of the NHI Bill as it stands now.”