NHI rollout nears its end
Patients to be issued with cards to collect free medication
AS THE first phase of the National Health Insurance rollout nears its end, patients seeking treatment at public healthcare facilities could soon be issued unique NHI cards allowing them to access services and collect medication at pharmacies without paying a cent.
The second phase is due to start early next year.
According to the NHI White Paper, during the start of the second phase, South Africans will be registered and issued with an NHI Card at designated public facilities using a unique identification code linked to the Department of Home Affairs.
The much-awaited policy document, published on Friday, stipulates that NHI card holders would not be expected to make any out-of-pocket payments, such as copayments and user fees, at points of healthcare delivery.
Vulnerable groups including children, orphans, the elderly, adolescents and disabled people would be prioritised.
According to the paper, a transitional fund would also be established to purchase primary healthcare services from certified and accredited public and private providers at non-specialist level. All suitable clinics would be accredited for accessing the fund, and in the later stages of the phase two rollout, all certified public hospitals, emergency medical services (EMS) and national laboratory health services (NHLS) would also be included.
User fees in the form of direct out-ofpocket payments in public hospitals would be abolished to improve access to services and to protect households from financial hardship. NHI would be funded by compulsory contributions, and would provide a basket of services from accredited public and private healthcare institutions. Private medical schemes would be allowed to offer “complementary services” not covered by NHI.
The document has largely been welcomed by the medical fraternity, but concerns have been raised.
Graham Anderson, principal officer of Profmed said the document didn’t clarify how it would “marry” the private and public healthcare sectors.
“I don’t think we have enough information on this document that explains how the two sectors are going to work together. I also think the 14-year implementation period it proposes is too short,” he said.
Anderson also warned Health Minister Aaron Motsoaledi to be careful in making sure that medical schemes were not “wiped out” by the introduction of NHI.
Mark Sonderup, deputy chairman of the South African Medical Association (Sama) said while the organisation was still “digesting” the White Paper, it was concerned with certain clauses in the document that might have serious implications in future.
While acknowledging GPs as the “cornerstone of healthcare delivery and there are a lot of positives”, Sonderup said it was
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2015 concerning that doctors were seen as the drivers of exorbitant prices in the private healthcare system. He said it looked like Motsoaledi had made up his mind about the drivers of costs in private healthcare despite a commission of inquiry into high costs not making any findings as yet.
Discovery Health chief executive Jonathan Broomberg said the White Paper sets out a “very bold and ambitious and detailed road map” for strengthening the national healthcare system at all levels.
“Our initial view is that the approach is comprehensive and appropriate,” he said.
Health MEC Nomafrench Mbombo said while the province supported the idea of universal healthcare coverage, the funding model contained in the White Paper “is both unfeasible, and unsustainable”.
“We are particularly concerned with the excessive centralisation which is a running theme throughout the document,” she said.