undergo both voluntary and regulatory reform to become aligned and consistent with the objectives of NHI, there will be a need to relook this. However, should this not occur, the medical schemes will conflict with the NHI principles and to mitigate the adverse impact on access to universal health coverage, their role will become limited to that of offering only complementary cover.
This is very real risk. The only way in which this can be averted, is for government to address issues with public health facilities - build confidence in these facilities and bring them on par with what people perceive as a difference in quality.
Under NHI, all facilities must deliver a defined minimum standard of care, and this places pressure on the government to ensure that public facilities are NHI compliant and ready.
How will you manage demand? Currently the medical aid can decline a request for a service because funds have been exhausted.
The medical schemes will be more tightly regulated. We will amend the medical schemes
Act to prevent this from taking place. The Prescribed Minimum Benefits (PMBs) will be replaced with a
For NHI to achieve universal health coverage requires a clear and firm commitment to partnership with the private sector. Politically and through stakeholders, including civil society, this must be appreciated and recognized.
The second biggest fear, is having public health facilities that do not meet minimum standards.
This requires a transformation within the public sector. If we don’t implement innovative ways of changing the way care is delivered, NHI could fail.
We need to radically transform our approach to administering and managing public health facilities. We need to find lower cost approaches to delivering care both within the public and private sector.
The lack of understanding of what we are trying to do is the biggest challenge. Within this, is the need to understand that this is a process of transformation and this requires that we sometime need to take different paths to achieve the same goal.
There must be a realistic and pragmatic approach that builds confidence and does not destroy what we have. This does not mean we
The implementation of NHI must focus on those in greatest need, the most vulnerable groups of our population, those that do not have or cannot afford cover.
We cannot start with those that already have cover. However, this does not mean we ignore the issues affecting the groups with cover. But we need to prioritise those in the most vulnerable groupings. For instance, one of the biggest concerns of people who have medical cover is that their funds get exhausted as early as June and they remain without cover for the rest of the year.
Through NHI-inspired initiatives such as price regulation of medical service and the reductions of the cover options, we will ensure that those with medical aid cover are indeed covered throughout the year. This is the biggest problem facing those who have medical aid cover at the moment.
On the other end of the spectrum, there are the unemployed who do not have any form of medical cover.
We will prioritise this section of the population by extending cover to them. The plan is to ensure that all South Africans are covered.