Business Maverick


National Health Insurance roll-out one step closer, but private healthcare has burning questions

National Health Insurance roll-out one step closer, but private healthcare has burning questions
Patients and staff at Rahima Moosa Mother & Child Hospital in Coronationville, Johannesburg, South Africa. (Photo: Spotlight)

Implementation will require significant investment in the health system as well as a phased approach to ensure that it is rolled out in a sustainable and effective manner.

The approval of the National Health Insurance (NHI) Bill by the National Assembly this week seemed to catch some by surprise, as the industry expected further amendments following widespread concerns.

The Bill still has to be approved by the National Council of Provinces before being signed off formally by Parliament and promulgated by the President. South Africa’s healthcare system remains unequal, with 84% of the population dependent on a heavily burdened — and in some cases under-resourced — public health system, with 16% on medical schemes.  

The NHI seeks to solve this disparity by redistributing resources to provide equitable access to healthcare.

However, implementation will require significant investment in the health system as well as a phased approach to ensure that it is rolled out in a sustainable and effective manner. 

“While the Bill ensures that medical schemes will still exist, they will be required to provide complementary cover to beneficiaries of the NHS,” said Dr Katlego Mothudi, the managing director of the Board of Healthcare Funders (BHF), at the recent release of the Sanlam Benchmark Survey. 

“Employers may be mandated to contribute to the NHI fund on behalf of their employees. This is of course subject to finalisation of the funding mechanisms.”   

The BHF, an industry body representing medical schemes (with the exception of Discovery Health medical scheme), has identified several anomalies in the Bill that require further attention and alignment with constitutional mastery. 

One of the first points the BHF raises is the fact that the NHI is not universal health coverage, but a funding mechanism. 

“Medical schemes, managed care organisations and administrators as well as other funders of health are an asset to the ecosystem and are geared to move our country to achieve universal health coverage,’’ said Mothudi. He added that although initial plans are for full implementation of NHI by 2026, this is looking increasingly unlikely. 

“It will probably be another 10 to 15 years before it is fully implemented, according to the Department of Health,” he said.

Material concerns

Dr Ryan Noach, the chief executive officer of Discovery Health, says he is surprised the Bill was passed despite “material concerns raised by almost all the opposition parties at the committee, and further to this, the significant constitutional concerns which were raised by the parliamentary legal adviser which seem to have been ignored”.

Noach says it is particularly concerning that the inputs of healthcare professionals, who are essential to the delivery of healthcare, were not given the appropriate weight and attention in the amendments to the Bill. 

“As a result, it appears highly likely that this Bill will be challenged through various legal avenues, including probably being contested on various constitutional grounds, based on multiple stakeholders’ stated intent during the PPC hearings premised on key issues which have not been amended.”  

How will it be funded?

The billion-rand question of how the NHI will be funded has not been addressed. 

“This is particularly concerning, given the minister of finance’s recent comments relating to the financing challenges and nascent stage of the Treasury’s work on NHI funding,” Noach says.

“It is absolutely critical to understand the affordability and economic strategy for supporting the Bill’s proposals, as well as the financial systems and controls required to ensure effective oversight of the monies in the fund. 

“Sans substantial financial support, the necessary health system improvements and the sustainability of this approach will be impossible. It is in fact a clear and present risk that the resources to support this proposed structure do not exist within our fiscus.”  

Sandra Sampson, director at Allmed Healthcare Professionals, says estimates for funding the NHI range from R165-billion to R450-billion. DM


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  • Alastair Stalker says:

    I watched Dr Nicholas Crisp on TV yesterday and I was confounded by how such an intelligent, articulate man could be so delusional. The implementation of NHI is going to be the death knell for health care in SA. I have Stage4 melanoma cancer and I’m being treated in an efficient, private oncology centre. Discovery pay for part of my very expensive treatment and I pay personally for the rest. NHI will be a death sentence for people like me as I don’t believe that it will be possible to pay personally for treatment like this under NHI. Of course, there will be a further exodus of medical professionals. The ANC will be unable to keep their sticky fingers out of a potential R450Bn pot and doctors and specialists will be at the mercy of faceless, incompetent bureaucrats. I suspect that Dr Crisp is a well meaning idealist who believes ardently in universal health care for all but is being duped by the clowns in political power.

  • Alan Paterson says:

    The fact of the matter is that this is the last kick of the donkey that is the ANC. Approval by the National Council of Provinces is guaranteed. Then the electioneering will begin. That it will be ten to fifteen years for “full implementation” (whatever that means) will be cast aside and the message to the masses will be one of vote for us and “very soon” your health will be fully serviced at your friendly Mediclinic/Netcare hospital. I feel for stalker who is entirely correct in that this will mean the exodus of doctors, as has been happening for decades, and I am deeply suspicious of “well meaning idealists” who simply cannot understand that the further exodus will be an inevitability. Doctors are highly qualified people with families and dreams and countries such as the UK, Canada, Australia, New Zealand, Ireland are all hiring.

  • Paddy Ross says:

    The NHS was established in 1948 and was funded by Government (aka taxpayers) at 100 million ponds sterling per annum. It was thought that as the backlog of disease was eradicated, the cost of running the NHS would drop. It now costs around 150 billion pounds sterling and even allowing for inflation, technical advances, and increasing longevity, the initial assumption of future costs was somewhat misplaced.

  • Riel Meynhardt says:

    Stalker is surprised by how an intelligent person such as Dr Nicholas Crisp could be so delusional. The ANC has him, as the Nazis had Dr Josef Mengele – the end result will be the same – thousands will die because of him. Crisp may be scientifically brilliant, but the mere fact that he can not look around him, at what the ANC has done to the public health system through their serial ineptitude and ingrained penchant for stealing, means that he is probably clinically delusional.

    The fact that the NHI Bill came out of Parliament with so many flaws and oversights should not surprise anyone – one the one hand the ANC has gathered the least suitable and qualified to populated the benches of this institution on their behalf. On the other hand the true motto of the party has always been: Everything we can’t steal, we will break”. They have broken the public health system and now want to steal this fantastic pot of money that they think the nationalization of healthcare will provide.

    The only spec of light at the end of the tunnel is that the sloppiness of the bill leaves it open to years of litigation.

  • jcdville stormers says:

    We are going full on towards communism,at least the goverment(kleptocracy) is.

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