Healthcare leaders reiterate NHI Bill concerns

Healthcare leaders have expressed concerns about the National Health Insurance (NHI) Bill, stating public healthcare funding should not rise at the expense of medical schemes.

They emphasise the need to clarify ambiguities in the bill before implementing NHI.

The Board of Healthcare Funders (BHF) recently held a briefing session with key figures including BHF managing director, Dr Katlego Mothudi, BHF chairperson, Neo Khauoe, Dr Stan Moloabi, chairperson of the BHF’s Universal Health Coverage Committee, Dr Mvuyisi Mzukwa, chairperson of the South African Medical Association (SAMA), Prof Alex van der Heever, an expert in healthcare governance at Wits and BHF’s head of health system strengthening, Dr Rajesh Patel.

Khauoe supports universal health coverage but strongly opposes the bill’s approach, increasing public healthcare funding at the expense of medical schemes.

“The private health funding sector in South Africa should not be sacrificed in favour of NHI. It is too valuable in terms of jobs, scarce skills, infrastructure, financial investment, the quality of the health care services its beneficiaries receive, the value it adds to the economy and the support it has lent to the public health sector.” 

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Minister gets too much power in NHI Bill

Patel highlighted concerns about section 33 of the bill, pointing out the need for clarity in the minister’s decision-making processes regarding the inclusion of rules for thorough implementation and the ambiguity in NHI contracting with health service providers. He says one of the bigger complications is where maternity care is excluded from the medical scheme’s benefits. 

“There are absolutely no indicators in section 33 to guide the minister about when NHI is fully implemented. Section 33 is therefore contrary to the constitutional principle of administrative justice and allows the minister to act arbitrarily.

“The minister’s determination is an administrative decision subject to section 33 of the Constitution and the Promotion of Administrative Justice Act and therefore it must be lawful, reasonable and procedurally fair.

“How will the minister know what will make his decision lawful if parliament gives him no guidance in the NHI Act? The minister is not the lawmaker. That is Parliament’s role,” Patel says.

Moloabi said medical schemes are important in healthcare provision and this importance is beyond just financial aspects.

“We face uncertainties regarding the specific details that will arise from the ongoing policy changes outlined in the NHI Bill.  As private healthcare funders, our primary goal is to actively collaborate with policymakers, which is crucial to our shared objective of achieving universal healthcare.”

According to Van der Heever, the NHI Bill will further undermine the already precarious situation of the South African healthcare sector.

“The discourse surrounding the move towards the achievement of universal health coverage in the country necessitates a comprehensive examination of the underlying goals associated with the concept of universal health care.

“Medical schemes are currently an integral component of the health system, providing cover for 9 million lives. The hybrid universal coverage model is widely employed across the globe. I am concerned that there is a single funder in the NHI Bill and about the pressure on the health care system should all citizens rely on a single scheme.”

He says a single fund is also an impractical approach for rich as well as developing countries and given South Africa’s limited GDP strength, such a proposition appears particularly unreasonable.

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Concern about accessibility rates

Khaoue also specifically emphasised the expected discrepancy in healthcare accessibility rates among employees under the NHI Bill in comparison to the existing system.

“The discrepancy is anticipated to extend the duration of employees’ recuperation, resulting in supplementary expenses for employers due to the postponed resumption of employees’ work duties.”

She says considering the democratic nature of South Africa, it is crucial to prioritise the provision of opportunities for South African citizens to exercise their autonomy in shaping their future.

Khauoe also questioned the means that can be used to mitigate discrepancies between private and public healthcare systems, particularly considering the existing difficulty of lengthy waiting times for various medical treatments.

“What strategies could be used to help the NHI Bill to simplify some of its processes, if, for example, you are prepared for a specific operation but there is no anaesthesia available and the procedure is not performed on the specified day, what then?”

In addition, she says, it is imperative to establish a reliable mechanism to guarantee that those who are scheduled for operations or procedures will indeed undergo them on the designated days without any rescheduling.

“This demonstrates the necessity of both public and private sector involvement in addressing and resolving existing imbalances as a primary concern.” 

According to Mzukwa, the NHI Bill has the potential to impose financial consequences on healthcare practitioners.

Though healthcare providers may qualify for payment for services provided to beneficiaries of the NHI, it is important to note that the rates for these services may be standardised.

“This standardisation could potentially lead to a decrease in their revenue compared to the fees charged in private practice. Therefore, it may be necessary for practitioners to adjust their financial expectations and business strategies.”

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Various consequences of NHI Bill

He said the potential consequences of NHI could vary significantly depending on the legislative and regulatory framework in place. “Nevertheless, it is crucial to consider the financial implications for healthcare professionals when finalising the NHI Bill. The most important thing is that, as private health care practitioners, we want to participate via collaboration with the policy makers to ensure that we achieve those ideas they have.”

Mothudi says the BHF is resolute. It aims to provide the health citizen with a comprehensive understanding of the potential implications, challenges and shortcomings of the NHI Bill.

This is crucial before the upcoming provincial briefing sessions to be convened by the government to foster transparency, informed public discourse and evidence-based policymaking in healthcare reforms.

Ultimately, the goal is to give South Africans a clear understanding of how the NHI Bill will affect their lives

He highlighted that the BHF firmly supports the freedom of the people of South Africa to spend their disposable income as they see fit, including insuring any of their health needs through medical schemes.

“This right is derived from the constitutional value of personal freedom in a democratic society and the rights to human dignity, privacy, freedom of association, freedom of thought, belief and opinion, as well as the right to have access to health care services and emergency medical treatment. The NHI Bill is anticipated to have a cascading impact on the already declining state of the public health system in South Africa,” Mothudi says.