What will signing of NHI Bill mean for you?
Some say it’s about delivering equitable services while others worry it will overburden an already strained system
The public announcement that President Cyril Ramaphosa will sign the National Health Insurance (NHI) Bill into law today has raised concerns.
Critics worry that the NHI could further strain the already overburdened healthcare system and force taxpayers to dig even deeper to finance what some perceive as an “ANC election gimmick”.
Stakeholders dissected every clause with the prognosis hinting at potential legal battles as the contentious legislation nears its final hurdle.
Eastern Cape health department deputy director-general Dr Mtandeki Xamlashe said the NHI was about providing equitable health services for all South Africans, despite economic background.
The government wants to create universal health coverage, which aims to create a single health system in which patients receive care that is free at the point of delivery.
“The NHI is a response to that anomaly within our healthcare system. There is inequity.
“If you have a heart attack in Bizana or in Summerstrand, chances of survival differ by 80% and you’re more likely to die in Bizana.”
Xamlashe said the country spent R300bn in terms of the health GDP and this was for both public and private sectors.
He said already the public sector took the bulk of the health burden, 85% of the population, and yet with the contribution of medical aids to private health care, this sector got almost the same allocation for 15% of the population.
“Over and above, the taxman also subsidises medical aids, usually at 60%, and that’s more money coming from taxpayers to private health care in terms of resources.
“That has to be harmonised. “The two sectors must find a way to serve this population to the same standard prescribed by the OHSP [Medical Surveillance and Occupational Health & Safety Programme].
“Going forward, medical aids will not be subsidised by the state. Members will be responsible for their full premium as Sars will be funding NHI,” Xamlashe said.
While the signing ceremony
will be a huge step towards the legislation aspect of the Bill, it will still be a few years before NHI is fully implemented.
Xamlashe said signing the Bill would be followed by an administrative element where structures would need to be set up.
“It may be setting up committees to ensure NHI is implemented properly, similar to hospital boards.
“After the Bill has been signed into law, I’m pretty sure the focus will be on building those structures to ensure a corruption-proof fund,” he said.
Aside from that, infrastructure development in public facilities still needed to be done to ensure NHI compliance, which could take several years.
“It’s a work in progress but it’s very impressive.
“There’s been a lot of progress in terms of achieving those standards in the Eastern Cape.
“We’ve improved infrastructure and some facilities have changed.
“So, in no time, you’ve seen new emergency departments and oncology centres like at Livingstone Hospital.
“It’s also an effort to try upgrade infrastructure.
“So, many other sites are undergoing an infrastructure overhaul, but that’s not enough, we’re also improving the equipment standard,” he said.
Xamlashe said the issue of surgical backlogs would be addressed and fine-tuned as implementing NHI was still a work in progress.
“All health systems of the world have long waiting lists.
“NHS [National Health Service] in the UK has a longer waiting list than the SA public health waiting list.
“Sometimes people complain they can’t get a prostate check in a matter of six months, meanwhile in other countries it reaches three years.
“That’s why our NHI must address those concerns.
“We must make sure they don’t have long backlogs and waiting times.”
Ramaphosa, addressing opposition to the Bill, said that it was the haves who were against the have nots enjoying the same benefits as them.
“The NHI is one of those focus areas which is going to help poor people,” Ramaphosa said.
“And now the opposition on NHI is coming from well-to-do and rich people. It’s coming from those who have the ability, and this is what often happens; the haves don’t want the have nots to benefit from what they have been having.
“And we are saying through NHI all our people must have equality, there must be a quality of healthcare in our country.”
Speaking at a business luncheon organised by the ANC yesterday, Ramaphosa said this type of opposition to equality was experienced when democracy was ushered in and all people were given the right to vote.
“And I know it drives fear into the hearts of many, just like for all our people getting a vote drove the biggest fear in the hearts of white people in this country, they were terrified.
“They were so afraid because they thought when everybody gets a vote, it means that the privileges that they always had are going to disappear,” he said.
Business Unity SA (Busa) said it was deeply concerned by the development as it believed the legislation was unimplementable and would damage the health system, the economy and investor confidence.
Busa had lobbied against the Bill, saying while it supported the need for reform, the legislation was unworkable, unaffordable and at odds with the constitution.
Busa chief executive Cas Coovadia said the organisation would consider its options after Ramaphosa’s announcement today.
“We fully support the objective of universal health coverage.
“However, the NHI Bill in its current form is not in line with the constitution.
“What is especially troubling is that the president is proceeding despite extensive constructive inputs made by a wide range of stakeholders, including doctors and healthcare professionals, civil society, public sector unions, academics and business.
“The unfortunate consequence is that this version will hamper, rather than promote, access to quality health care for all.
“Our subsequent actions will be guided by our belief that it is essential we get the NHI right through all means still at our disposal, including appropriate legal interventions so that the legislation that is finally implemented is in the best interest of our country and its people for generations to come,” Coovadia said.
With fewer than 15 days to go until the elections, SA Medical Association former chair Dr Angelique Coetzee believed the signing of the Bill was due to political pressure.
“Whatever the reason, we know the government’s plans for NHI will most likely take many years to be implemented because there is limited scope to fund it with higher taxes,” Coetzee said.
She said there had been no costing published by the health department as required by law.
“It’s not been done. So, we don’t know what we are going to be getting.
“We all agree the country’s healthcare system requires reform, but the NHI Bill in its current form is not economically viable for SA.
“It will either require that VAT be increased from 15% to 21.5%, or personal income tax increased by 31% across the board.
“So, substantial tax increases will need to be implemented, and currently we know our economic environment is extremely tough,” Coetzee said.
Health Funders’ Association chair Craig Comrie said there was a long way to go towards building confidence in the public health system, and the state’s capacity to effectively manage a single pool of funds as envisaged in the NHI Bill.
“Currently, state clinics and hospitals are overwhelmed, struggling to deliver the most basic care, often inadvertently risking lives.
“If private health care can no longer alleviate at least some pressure on the public system, the NHI’s promised reforms will not be realised.
“The emotive political rhetoric around NHI recently does not consider the transformative power of shifting more people to private health care, thereby improving access to quality health care and resource allocation, which weigh heavily on public facilities and those reliant on them,” Comrie said.
According to Comrie, if the NHI Bill were enacted by Ramaphosa with Section 33, which precludes private health funding involvement, it would have devastating consequences.
“Such a move would erode the current world-class private healthcare system and further threaten the country’s already stretched healthcare provider base,” he said.