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.
Read in Daily Maverick: “Mixed feelings about NHI at public health conference”
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
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The NHI funding system will ensure quality healthcare access for all and thus ALL will be sleeping on the floors in overcrowded wards, waiting years for surgeries, being wheeled past derelict half-completed operating theatres to the only functioning theatre which has no sterilised instruments and of course ALL will be bringing along bottles of water to flush the toilets. ALL will experience our new hospital grade blankets and sheets – repurposed from an entirely unrelated order of skinny jeans.
The bill will establish and maintain an NHI Fund which will buy luxury mansions on behalf of incompetent and corrupt NHI managers – from the NHI fund itself!
Through IMBECILIC purchasing the NHI Fund will ensure the equitable and fair distribution and use of single patient scooter ambulances.
Once the NHI has been fully implemented, the single medical scheme left in the country must only offer complementary cover (ie. herbal remedies, homeopathy, acupuncture, and pilgrimages to Lourdes) to services not reimbursed by the fund.
The bill is a system intended to ensure that the use of health services does not result in TOO MUCH MEDICAL RISK to the people, and it seeks to ensure universal CT scans for all, based on a bilateral with HITACHI to supply scanners on condition that the country experiences scanshedding only twice a week.
South Africans need to be reminded that the NHI cannot happen overnight so as an interim measure we will be resurrecting SAA to fly (neutral) patients to Russia for treatment. Business class seats will be allocated fairly and equitably to government ministers, their friends and families, and Indian wedding parties.
Brilliant!!!
Thanks Chris
How else then.
Quite simple. In my ideal world:
1. The government sets out the vision for the NHI
2. Parliament ensures that that vision aligns with the the tenets of the Constitution
3. The Judiciary tests the alignment
4. Most importantly…the State contracts private providers (Mediclinic, Netcare, doctors, medical aids for funding expertise, et al) to run and manage the NHI whilst policing things like price-gouging and minimum standards
5. The private providers market and offer a range of top tier for-profit services (private rooms, cosmetic surgery, fast referrals, etc) funded solely by contributions from members of medical aids
6. Everyone takes a hit: tax-payers, the private sector, investors and shareholders, SOEs. Through RINGFENCED contributions!
Bang on the money of course Crispy won’t be reading this.
First fix the mess of corruption and waste that is the public health system, and then we can begin the conversation about the NHI. As it stands now, it will just be another vehicle of corruption and theft. At every opportunity the ANC has shown that it simply cannot administer even tiny public funds without large amounts being stolen. There is literally no reason why the NHI should be different. All it would do is destroy healthcare for those that are fortunate enough not to have to rely on the thieves and crooks that run the current public health care system. Just about every other country that has a NHI allows private medical aid in parallel, yet you guys have to force the issue because you KNOW you cannot even begin to stem this problem by yourselves, and no, it’s not because you are getting to little money, its because you are stealing and wasting most of it. Get your stuff together and then we can start chatting again.
How would this change the fact that thoroughly incompetent and corrupt bureaucrats have wrecked the public health system? Public hospitals have all deteriorated in the last two decades while billions have been stolen or misappropriated in some way.
Like many political academics, the writer is distanced from the harsh realities of government disfunction and unintended consequences.
The NHI is a laudable ideal but firstly completely unaffordable.
Secondly it will see an exodus of medical professionals and thirdly many successful job creating entrepreneurs will leave the country as creeping socialism removes freedom of choice.
Honours you are part of the massive problem this country faces- leave well alone and focus on fixing the economy by getting government out of the way. Then use increased taxes from such growth to professionalise the public health care sector and remove BEE so that the poor benefit from merit based appointments.
Lift up your eyes!!!
Where is this doctor living? It is not the fear of the unknown that causes apprehension about the NHI. It is the fear of the very well-known, viz. the fear of corruption.
My dear chap
It is well understood in this country that the present government cannot run a bath, let alone a hospital, don’t even mention the NHI.
Yet another piece of unimplementable legislation will not fix this. Some (but not all) important prior things to sort out:
– the budget for NHI and its devastating impact on the economy.
– the exodus of doctors and other health professionals who will not accept being told how and where to work at unacceptable salaries.
– the fact that the majority of public hospitals are disfunctional as it is.
– the certainty of industrial scale corruption in a central procurement structure, which will lead to immense wastage and losses.
Does anyone really believe this can work? The numbers simply do not. Notice how NHI is used to avoid actually fixing Government hospitals and clinics.
Sounds fantastic! When can we all start getting the new NHI drugs that the author of this fairy tale is on?
Please god bury that stupid in your head for as long as you can so we’re not exposed to it. You’re taking politics and not reality and we will all be much worse of. You can’t manage a bloody post office and now you feel competent to take this on. I for one will not t leave my assets in this country to be abused and stolen by the eternal stupid and corrupt.
“the gap of inequalities in accessing healthcare is becoming wider”
And have you interrogated WHY that is? It’s quite simple really: corrupt government and their abysmal economic policies.
But you think the NHI will solve the problem? All the NHI will do is to implement an abysmal economic policy and give a corrupt government control over the lives of every South African.
If you want equality in health, start by making sure 95% of taxes are spent where they are intended at a market related price, and that includes on salaries for competent staff! Then, learn a bit more about the modern economy and allow people to live independent lives running their own businesses.
Clearly some vested interest from the author. He is driving an ideological concept that will not work in any African country. As has been mentioned on many occasions here, there is no way that the crooks, fraudsters (read ANC & its cronies) & their cadres will allow this opportunity to pass without lining their pockets before it fails like everything else they touch. Let us hope that it is not implemented before 2024.
All the above is rhetoric, the truth is the ANC has looted or broken everything they inherited, how on earth can we allow the same people to have access to such large of money without scaling most of it. Sorry once bitten…
Thanks for the insight, here are glaring concerns that remain regarding NHI:
1)Effort, there is nothing against effort being used as a basis for equality, for its fair to treat people according to their deeds. NHI must clarify why current profit models that equate affordability with equality are wrong.
2)Equitable, how is it fair to subsidize those who can afford more who those who cannot afford if it tries to solve the affordability issue, merely redistributes income equality (health to investments)
3)availability, if everyone can afford health services what is to guarantee that all will benefit, if there will be always some needing health care but cannot afford it, it seems NHI will worsen scarcity.
4)distort cost formula to mask profit, will kill rather than revive competition and lead to substandard quality.
5)need is not disability, for if the need to health care remains unfulfilled, that doesn’t imply disability but lack of responsibility (make provision)
6) Constitution has proper and adequate tools to remedy this situation without creation of NHI, thus it seems more ideological rather than pragmatic (configure current sources)
More can be said…