Don’t panic about NHI, head of medical scheme says

There is no need to panic about the fact that the president signed the NHI Act into law, says a medical scheme CEO, while a governance expert says it will take government about 1 000 years to implement.

Teddy Mosomothane, CEO of Bankmed, wrote in a letter to fund members last week that the signing of the Bill will have no impact on medical schemes for many years. He says although it is disappointing, it was not unexpected.

“What makes this rather very unfortunate is the fact that the stakeholders (including Bankmed) who were opposed to the NHI Bill are generally very much in support of Universal Health Coverage (UHC) as the overarching objective and believe that collaboration with government could achieve this.”

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He says this is the position and reality that is sadly suppressed by the political noise and rhetoric. “However, in our view, the NHI Act in its current form, which imposes a limitation on the role of medical schemes, undermines UHC and will be to the detriment of the population of South Africa.”

The opportunity to collaborate, which would ensure an inclusive and sustainable healthcare solution, was unfortunately not embraced by the signing of the Bill, he writes. He indicated to members before that if the president signs the NHI Bill, the next avenue available is to challenge the NHI Act legally on constitutional grounds and that Bankmed intends to participate in doing this.

“That is where we are now and Bankmed is part of a collective that will be challenging this via the Health Funders Association (HFA). Many other stakeholders will do the same.”

This is why you should not panic about the NHI Act

Mosomothane says these are the reasons fund members should not panic about the NHI Act:

• The NHI Act, in its current form, will be legally challenged (but this takes nothing away from our continued support for a rational, inclusive and collaborative pursuit of UHC)
• It will take a very long time (and estimates suggest 10 to 15 years) before NHI is “fully implemented” and the NHI Act (as it is now) suggests that is the point at which medical schemes will not be able to provide cover for services NHI pays for
• The unfortunate financial constraints that our country faces currently make it impossible for the implementation of NHI to present any threat to the continued existence of medical schemes for the foreseeable future
• Even when NHI is fully implemented based on the NHI Act as it is now, medical schemes will be allowed to exist, but (and this is what we are opposed to) confined to what is not covered by NHI. It is currently not clear what will be covered by NHI, but the financial constraints and the implications of NHI cover available for the whole population in the country leaves substantial room for the role of medical schemes
• Even the minister of health, Dr Joe Phaahla, is quoted as saying at the signing ceremony “please don’t cancel your medical aid”.

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NHI Act ‘far too complex for government to achieve‘

Meanwhile it is also important to remember what Professor Alex van den Heever from the Wits School of Governance told news channel eNCA a year ago after the National Assembly passed the NHI Bill: that it will take 1 000 years to implement as it is “far too complex for this government ever to achieve”.

In the interview, Van den Heever said the proposals in the NHI Bill are financially and institutionally impractical. He pointed out that government wants to consolidate the public and private healthcare sectors into a system that does exist yet. “This will be done by a department and government that cannot run state institutions effectively.”

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Van den Heever said it is “far too complex for this government to achieve” and that the National Assembly only passed the NHI Bill to make it look like government is doing something. “The NHI Bill is merely window dressing health reform and is not substantive.”

He said the can will just be kicked down the road and that “nothing of substance will happen”, pointing out that NHI has become a political tool for the ruling ANC in South Africa to score political points. The NHI Bill is “not a true, public interest-oriented health reform”.

Instead, Van den Heever said, government failed to tackle any of the problems in the existing public healthcare system and should start there first. While South Africa’s public healthcare system has the potential to be highly functional and is on par with the best systems in the world on paper, government has failed in reality to make high quality healthcare a reality for most people.

He said the problems in the country’s public healthcare system can be fixed without implementing NHI, as public healthcare does not have a structural or resource problem. It has a governance problem and a lack of effective oversight and accountability.