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The South African Medical Association is questioning the health minister’s “sudden move” to implement the recommendations of the Health Market Inquiry and finds his delayed response after six years “troubling”.
The Health Funders Association, on the other hand, says it is “encouraged by the minister’s commitment to revisit the recommendations”.
Responding to weekend reports that the ANC has reached a compromise on the implementation of the National Health Insurance (NHI), Dr Aaron Motsoaledi, minister of health, said last week he will call a press conference in the coming weeks to elaborate on the way forward with the recommendations.
The Competition Commission initiated a Market Inquiry into the state of competition in the private healthcare sector (HMI) in November 2013. The final report of the Health Market Inquiry, chaired by the former Chief Justice, Sandile Ngcobo, was published in September 2019. Only limited progress was made to implement the recommendations.
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Dr Mzulungile Theo Nodikida, CEO of the South African Medical Association (Sama), says the association acknowledges the importance of addressing private healthcare market inefficiencies as identified in the Health Market Inquiry report and remains supportive of several key recommendations, including the establishment of a supply-side regulator.
“However, Sama must express concerns about the national department of health’s sudden move to implement the recommendations and implores the minister to work closely with healthcare stakeholders on the execution.
“While we appreciate the thoroughness of the Ngcobo inquiry in its time, the minister’s delayed response to these important findings is troubling. The healthcare sector has waited nearly six years for departmental action on the recommendations.
“During this time, the landscape was dramatically transformed by the Covid-19 pandemic and other significant developments. This delay allowed identified inefficiencies to persist unnecessarily, potentially exacerbating challenges within our healthcare system.”
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Nodikida says Sama emphasises that while the recommendations of the Inquiry and the NHI scheme are both related to healthcare reform, they are distinct matters that require separate careful consideration.
“Sama’s support for some of the recommendations should not be interpreted as an endorsement of the current NHI implementation approach. We strongly urge the minister to engage in meaningful consultation with healthcare stakeholders before proceeding with any implementation plans.
“Furthermore, we maintain that updated research is essential to ensure that any interventions reflect current market conditions rather than relying solely on a pre-pandemic analysis.”
He says while the department’s belated attention to the recommendations is welcome, it must be accompanied by a contemporary assessment of their applicability and implementation implications in 2025’s healthcare environment.
“The South African public deserves carefully considered, well-researched healthcare reforms based on current realities and developed through proper consultation with all stakeholders in the healthcare sector.”
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Thoneshan Naidoo, CEO of the Health Funders Association (HFA), says the association is encouraged by the minister’s commitment to revisiting the recommendations. The HFA is a non-profit organisation representing stakeholders involved in the funding of private healthcare in South Africa.
“Although the report was compiled between 2014 and 2019, its extensive analysis remains highly relevant today, offering valuable insights into addressing systemic challenges and improving sustainability and affordability in the private healthcare sector.”
Naidoo says the HFA shares concerns over the rising costs of private healthcare and supports the proposed reforms in the recommendations that include establishing a supply-side regulator, introducing a standardised benefit package, implementing a risk adjustment mechanism, reforming the HPCSA ethical rules and creating an outcome monitoring and reporting organisation.
“These measures are designed to enhance equity, transparency and sustainability within the sector. Revisiting and implementing these recommendations present a significant opportunity to address ongoing challenges and strengthen our healthcare system.”
Asked if the department is not trying to take a shortcut by implementing the recommendations to avoid doing more research to establish how much the NHI will really cost, Naidoo says costing the NHI is an essential and non-negotiable step for its success and sustainability.
“Policymakers have a duty to base decisions on transparent, evidence-based analysis to fully understand its risks, benefits and financial implications, given the NHI’s profound impact on South Africa’s 60 million people and 8 – 9% of its gross domestic product.
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Professor van den Heever, Chair of Social Security Systems Administration and Management Studies at Wits said last week he believes the recommendations should be implemented in full, but he noted that the National Department of Health has demonstrated little understanding of the proposals themselves or the required processes needed to implement them.
“The Inquiry addresses systemic market failures in the private health system and involves a discrete set of reforms. The Inquiry should form part of a comprehensive set of reforms to the health system. Unfortunately, the National Health Insurance (NHI) proposals are not that reform and will likely never be implemented or be successful if implemented.”
Dr Simon Strachan, CEO of the South African Private Practitioners Forum (SAPPF), said last week that the forum has been advocating for the implementation of the recommendations throughout the NHI process.
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“The recommendations provide practical initiatives to improve the regulation and functioning of the private healthcare sector. It is wiser to use these recommendations that were well articulated by the Inquiry than relying on any other proposal that has not been through the rigour of developing these recommendations.”
The SAPPF was a founding member of the Universal Healthcare Access Coalition (UHAC). It published its proposal in December. The SAPPF commented in the proposal regarding the recommendations that a process is required to properly take the detailed recommendations of the Inquiry forward.
“No process has existed, to date, to address the recommendations, with important implications for the governance of the private health system,” the SAPPF said.
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