NHI Act will not ensure universal healthcare soon

Now that the NHI Act has been signed into law, the bad news is that it will not meaningfully change the healthcare experience for most South Africans for years to come.

The process towards fulfilling the promises of the National Health Insurance (NHI) will be a complex and unprecedented process that will necessitate extensive reorganisation of the healthcare sector, says Craig Comrie, chairperson of the Health Funders Association (HFA).

“There are various paths towards Universal Health Coverage (UHC), and collaboration with private healthcare funders can bring the benefits of more equitable access to quality healthcare to millions more South Africans,” he says.

The HFA is a non-profit organisation representing stakeholders involved in the funding of private healthcare in South Africa and represents around 73% of the country’s more prominent medical schemes and 43% of South Africa’s total medical scheme membership base.

“The signing of the NHI Bill into law will shape South Africa’s healthcare future, but at present there is no threat to medical scheme members’ benefits as the implementation of the NHI Act will be constrained by significant financial and structural constraints and complexities, not to mention legal challenges.”

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‘Rather stay with private health care for now‘

Comrie says until the NHI Fund and public healthcare system are ready to support quality, dignity-affirming healthcare, private health cover could offer an effective means of elevating the standards of care and extending access to millions more South Africans.

“With the finalisation of long-awaited regulations, such as those pertaining to Low Cost Benefit Options (LCBOs) and regular Prescribed Minimum Benefit reviews, real and lasting progress towards the goals of UHC could be made,” he says.

“We remain concerned about the long-term implications of certain sections of the NHI Act and its ramifications for the quality of healthcare for all South Africans, the sustainability of the healthcare system and by extension, the rights of patients to quality care.”

Watch: NHI Act signed – what now?

Comrie says what is needed is for all in the healthcare sector to unite their efforts to build a workable integrated funding system incorporating multiple funding streams and collaborative engagement to benefit everyone in South Africa.

“There are workable alternative approaches which can achieve universal healthcare without compromising the freedom of individuals to choose how to fund their healthcare needs. Where constitutional and other legal issues exist, we will take the necessary action to protect the constitutional rights of individuals and their medical scheme benefits.”

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No equity in healthcare in NHI’s current form

In its current form the NHI Act will not achieve equity in healthcare and there are better ways to achieve the genuine objectives of Universal Health Coverage, Comrie says. “We take the duty to protect access to quality healthcare in line with citizens’ constitutional rights very seriously and will not be deterred.”

Now that the NHI Bill has been signed, South Africans are more confused than ever before, Shaun Meintjes, franchise principal and financial adviser at Consult by Momentum, says.

“While most people have some level of understanding of what the NHI is, the vast majority are still not clear on what the NHI Act entails. What does it say? What happens next? And practically speaking, does this mean we should cancel our medical health cover?”

Meintjies says people should definitely not cancel their medical health cover. “South Africa has committed to implement universal health coverage for all, with the desired outcome that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.”

This is where the NHI comes in. According to the department of health, the NHI is a fund government will use to buy healthcare services for South Africans from providers across the public and private sectors.

“The purpose of the NHI is to make healthcare more affordable by reducing the cost of healthcare for all. It acts like a medical aid for everyone and South Africans will contribute to this fund through taxes and special contributions in line with what they can afford.

“It will ensure that everyone is entitled to free healthcare when they need it. There will be no fees charged at the health facility because the fund will cover the costs of care. This goal of equitable healthcare is extremely important and something we should work towards, but there are a couple of concerns with the NHI Bill in its current form.”

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No more medical schemes when NHI is implemented

According to Dr Larisse Prinsen, lecturer at the University of the Free State, once the NHI Act is implemented, medical health schemes will not be able to offer any services covered by the NHI and will only be able to provide for complementary or top-up cover that does not overlap with what is already provided for by NHI.

Meintjes says that as a result, health professionals fear that the NHI will pose a threat to private health insurers, who are still not sure exactly which treatments, health products and services will continue to fall under them and will be covered by the NHI.

In its current form, the Act has also been rejected by the South African Medical Association, multiple court cases have been launched against it and different voices, mostly in the political sphere, have been raised, warning of its pitfalls.

Meintjes, who has over a decade’s worth of medical health experience, says that South Africans should not view the NHI as a quick-fix solution to the current state of the South African health sector. “If you can afford it, I would strongly caution against cancelling your current medical health cover any time soon.”

Reasons to keep your medical scheme membership

He says people should keep their medical scheme membership because:

• The current estimated ratio in the public health sector is one doctor to around 2 457 patients, while in the private health sector the estimated ratio is one doctor to 571 patients. With the introduction of NHI and people rushing to cancel private medical health cover, these ratios might only worsen, as there remain insufficient resources to meet the needs of all South Africans. There is a real risk of overburdening the system, leading to longer wait times, decreased attention to individual patients and potentially a diminished quality of care.
• There is a lack of clarity around what the NHI covers. Currently, there is no clear definition of services covered by the NHI and it appears that this definition will only be expanded on an incremental benefit and geographic basis. Because so many important aspects are still unclear, the NHI will likely take many years to be established. Those with specialised healthcare needs may find that their treatments or procedures are not adequately covered under the NHI, especially in its early stages. This could result in individuals having to seek out-of-pocket payments or forgo necessary medical interventions, potentially worsening their health outcomes.
• Administrative complexity is another problem. The transition period from private medical schemes to the NHI may introduce administrative complexities and uncertainties. Members may face challenges in accessing the same level of care they were accustomed to under their private medical schemes, especially during the initial stages of implementation.
• There will also be a possible slowdown in innovation. The potential impact on healthcare innovation and medical technology advancement is a significant concern. Private medical schemes often drive innovation by investing in cutting-edge treatments and technologies. With a shift towards a single-payer system like the NHI, there may be less incentive for innovation, ultimately limiting access to the latest medical advancements for South Africans.

“There is still a great deal of uncertainty around the NHI’s roll-out and this ambiguity is expected to persist for the near future. I would advise holding onto your cover while any teething pains are addressed over the coming months or possibly years, ensuring that you have access to quality healthcare when you need it.”