NHI – The right prescription for South Africa?
The NHI puts too much power into too few hands; The potential for looting the fund is real
The issue of quality affordable universal healthcare for all South Africans was tackled during a robust forum on the National Health Insurance (NHI) Bill. Most agreed that the current healthcare system is unsustainable and requires complimentary private and public sector partnerships in order to survive and thrive.
The Mail & Guardian hosted the forum on Wednesday, October 4 2018 at the Glenhove Conference Centre in Johannesburg in partnership with the Government Employees Medical Scheme (GEMS), it sought to unpack the theme of “National Health Insurance: implications, challenges and the future”.
With stakeholders representing various entities within the healthcare sector in attendance, various pertinent issues regarding the NHI Bill were addressed. Robust discussions and an interactive audience debated concerns relating to co-payments, brokers and their role in the value chain, the new role and structure of medical aid schemes, affordability and funding models as well as what the new landscape of South Africa will look like.
Dr Anban Pillay, deputy director general of NHI for the department of health delivered the keynote address, during which he reiterated: “The role of the NHI Bill is to create common sources of funding to provide access to quality health services for all South Africans, based on their health needs, and irrespective of their socio-economic status.”
A policy shift and reorganisation of the entire healthcare system in South Africa is required, as the current models are unsustainable. The Bill consists of three phases, concluding in 2026. Currently in its second phase, the NHI Bill aims to provide universal healthcare through a single fund system, according to the country’s NDP plan for 2030. “We will start with the most vulnerable groups, eventually including other sectors,” says Pillay.
South African citizens, inmates, children and permanent residents will have access to the NHI. Refugees and asylum seekers who have not received refugee status will only have access to emergency and basic paediatric and maternal services, and for conditions of public concern, such as TB.
Professor Laetitia Rispel, head of the School of Public Health at the University of the Witwatersrand, was quick to highlight the need for inclusive engagement going forward. She noted that there is a need to avoid a single narrative around healthcare; engagement with healthcare professionals and patients is vital for progress.
It emerged at the forum that the quality of healthcare available is the real cause for concern. Professor Roseanne Harris, senior policy actuary at Discovery Health, stated, that on paper, South Africa already has most elements of universal healthcare — it is just how we deliver it that is currently failing. South Africa spends more on healthcare than any other developing country but the outcomes are terrible, according to Dr Brian Ruff, founder and chief executive of PPO Serve.
Dr Guni Goolab, Principal Officer for GEMS, notes that current healthcare delivery models are unsustainable in both the private and public healthcare sectors. “The status quo is not an option and therefore this calls for leadership to drive the reforms to achieve universal healthcare coverage. Consolidation of options is also important; members are often bewildered by the complexity of benefits available.”
It was noted that the sources of funding for the NHI will be jointly determined by the minister of health and finance on an annual basis. Various streams of taxation could fund the NHI including VAT, income tax and payroll deductions.
The issue of leadership and accountability was also a major cause for concern. Marije VersteegMojanaga, director of the Rural Health Advocacy Project, noted that this is a cause for concern, as the NHI puts too much power into too few hands. The potential for looting the fund is rife. She was concerned that “rural areas may be left in the lurch if they cannot comply with NHI standards”.
The escalating national health crisis in both the public health and private sector requires a collaborative effort from all sectors if it is to work effectively. The private sector is riddled with schemes that are unaffordable and public health sector faces its own set of challenges in terms of good governance, infrastructure support, its understaffed and underresourced facilities, among many other pertinent issues.
Quality and accessibility are key if we are to achieve the UN Sustainable Development Goals in achieving universal health coverage, including financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality and affordable essential medicines and vaccines for all.
It was concluded that government’s plan to implement the NHI and set up a universal healthcare fund for all requires innovation, accountability, collaboration and consolidation from all the stakeholders concerned.