While there are widely diverging views around the implementation of the National Health Insurance (NHI) scheme, it is generally agreed that the health system is under severe strain and the gap of inequalities in accessing healthcare is becoming wider.
The NHI has become a major point of contestation in the public discourse – so much so that we have even forgotten the fundamental motive in realising that its objectives are guaranteed in Section 27(2) of the Constitution which clearly states that “the state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of the right of access to healthcare services”.
The goal of the NHI is to ensure equity and equal access to quality healthcare services based on health needs, and not on affordability. The strategic objective of the NHI is ultimately to achieve universal health coverage for all South Africans, based on the principle of social solidarity.
We believe that the different stakeholder submissions to the Parliamentary Portfolio Committee on Health will assist the committee in strengthening the NHI Bill before its presentation for adoption in Parliament.
The Progressive Professionals Forum (PPF), which prides itself on encouraging and nurturing progressive thinking, has for a long time publicly supported and recognised the importance of the NHI Bill solely because our country is faced with myriad healthcare challenges. The bill is a critical and indispensable vehicle that can transform healthcare towards a unified private and public healthcare system.
It is indisputable that the NHI will transform the current two-tier health system into an integrated, unified single system and will be a solution to the structural challenges in both the private and public health sectors. The NHI is the biggest transformation programme of the health system and is without a doubt, the most complex system to be implemented since the dawn of democracy. It should not be a surprise that the fear of the unknown will kick in.
During the nationwide public hearings by the Health Portfolio Committee in 2019, the PPF hosted seven NHI public participation workshops and presentations in five different provinces. These were attended by about 600 healthcare workers, academics and professional associations mainly from the private healthcare sector.
Many stakeholders are apprehensive about the implementation of the NHI, however this apprehension is informed by fear of the unknown and a lack of communication.
The PPF supports the NHI Bill, and our recommendations on the bill are based on the inputs received during our nationwide public engagements with professionals, academics and business in different sectors.
The PPF endorsements of the bill include:
- The NHI funding system will ensure quality healthcare access for all South Africans irrespective of their socioeconomic status;
- The bill is a system intended to ensure that the use of health services does not result in financial risk to the people, and it seeks to ensure universal health coverage for all, based on health needs and not affordability;
- It provides for cross-subsidisation across all sectors of society, rich and poor, young and old, employed and unemployed, the physically abled and people with disabilities;
- The bill will establish and maintain an NHI Fund which will buy health services on behalf of the population from accredited private and public healthcare service providers;
- Through strategic purchasing as the single purchaser and a single payer of healthcare services, the NHI Fund will ensure the equitable and fair distribution and use of healthcare services;
- This equity and fair distribution of healthcare services will be further enhanced by Section 33 of the NHI Bill regarding the role of medical schemes in the NHI;
- Once the NHI has been fully implemented, medical schemes must only offer complementary cover to services not reimbursed by the fund. This will ensure that the state complies with its constitutional obligation of the right to free, quality healthcare for all irrespective of socioeconomic status; and
- About 8% of the country’s GDP is spent on healthcare services. Of this almost 4% is spent in the private health sector which services only 16% of the population, and the other 4% is spent in the public health sector which services 84% of the population. This is an anomaly that is not sustainable and as the PPF we believe that the NHI system is the only solution.
For any development to make a meaningful difference and be collectively embraced, the PPF agrees that concerns should be addressed as well. These include the lack of capacity and poor infrastructure in the public health sector and inequality and imbalance between the urban and rural health sectors.
Furthermore, the NHI Bill does not make provision for traditional healers, religious leaders and traditional medicine practitioners who can play a role in the primary healthcare system. There needs to be clarity on the system to be used for the reimbursement of primary healthcare service providers and the role of general practice in its current form (solo practices).
The above concerns, among others, were submitted and presented to the Portfolio Committee on Health during the public hearings.
With all the current challenges facing the national healthcare system in the country, and as outlined in the Health Market Inquiry report, the implementation of the NHI must happen without any further delays.
We commend the National Department of Health for creating 44 positions as part of the process to establish a fully functional NHI branch in the department, pending the finalisation of the NHI Bill in Parliament. The advertising of these vacancies is a clear demonstration of the political will of the current government to prepare for the implementation of the NHI as soon as the bill is passed in Parliament.
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It is important to note that the NHI is a healthcare funding mechanism and the bill will enable the establishment of the NHI Fund. However, both the public and private sector at provincial, regional, district and local levels should focus on preparations for the implementation of the NHI by strengthening their healthcare systems and improving their infrastructure as set out by the Office of Health Standards Compliance established by section 77 of the National Health Act. This will ensure that most facilities will be ready to be accredited as service providers by the NHI Fund upon the passing of the legislation.
This state of readiness can be achieved through the acceleration and implementation of the Quality Improvement Plan (QIP) intervention programme at all levels of care, especially primary healthcare.
The NHI Bill will enable funding of the healthcare services, but it remains the responsibility of the services providers, private and public, to improve their facilities in order to comply with the set standards required for accreditation by the NHI Fund. It is of great importance to understand that the NHI Fund will buy healthcare services on behalf of the population from both the public and private sectors. These services will be free at the point of care from an accredited service provider, or when referral protocols have been adhered to.
South Africans need to be reminded that the NHI is not an event but a process and cannot happen overnight, but it will happen over time. It is about addressing inequality in healthcare services and not about free market concerns or satisfaction.
Covid-19 has taught us that the public and private health sectors need each other to address the health needs of the population. DM