NHI benefits and implementation remain undiagnosed

Hundreds of medical professionals who packed the lecture hall at the Cape Town International Convention Centre on Monday to hear the minister of health talk about the National Health Insurance (NHI) were left with more questions than answers.

Speaking at the Hospital Association of South Africa’s annual conference, health minister Zweli Mkhize waxed lyrical with several quotes from the father of the nation, Nelson Mandela, but didn’t bring any new information regarding implementation of the NHI to light.

Where will the money come from?

Mkhize did commit to a seven-year government plan to fill vacant posts and finance refurbishing and development of new infrastructure, in order to meet capacity requirements when the NHI is fully implemented.

“We will be introducing the changes gradually and intend to have full implementation by 2026. There has been a great deal of robust discourse in recent weeks. I want to clarify that the sources of funding will be varied,” he said.

Mkhize backtracked somewhat on the figure of R30 billion, which has been bandied about in relation to the NHI, saying that the Department of Health (DoH) is in continuous consultation with National Treasury. “It will be tabled at an appropriate time in a money bill by the minister of finance.

“The money bill will have exact amounts and this will come … but not at this time. There is some work being done around costing beyond the next five years, but this is a work in progress,” he said.

What services will the NHI provide?

Mkhize said challenges facing the public health sector include long queues, staff shortages, dilapidated infrastructure, inefficient management, corruption and drug shortages – but did not elaborate on how these issues would be addressed.

However, he went on to say that the NHI espoused the principle of social solidarity where “we share resources and cross-subsidise one another”.

“The package of health services offered under NHI will be tailored to what our available resources will be able to afford,” he said.

Under the NHI, patients will be required to register with their local doctor, clinic and pharmacy in order to facilitate swift processing of their claims. Deputy director-general for the NHI, Dr Anban Pillay, told the conference there would be a strong focus on primary care as the first point of reference.

This effectively means the NHI will not pay for a patient to go directly to a neurologist if they are suffering from chronic headaches – the patient would have to consult with their doctor (general practitioner) and be referred to a neurologist before any claim from the neurologist could be covered.

“The GP will become the gatekeeper,” Pillay explained.

He also noted that the package of services offered under the NHI might not necessarily be the same each year – bringing to mind a system similar to that of current medical aids, which change their benefit options on an annual basis. Pillay said the minister of health would announce each year what services would be covered under NHI and any remaining services could then be covered by medical aid schemes.

Sharing of information between public and private sector

Mkhize said the DoH would be looking at initiatives such as a central chronic medicine dispensary and delivery system and introducing concepts such as ATM medicine dispensaries. In response to a question from the audience, Pillay conceded that the finer points around practical implementation of the NHI still needed to be ironed out.

“There would have to be some sharing of patient records when it comes to chronic medication to avoid patients having to go through the chronic medication approval process again,” he said.

Jonny Broomberg, chief executive of Discovery Health, the country’s biggest medical scheme, seemed upbeat about the introduction of the NHI, noting that “government should let the private sector in the door rather than trying to reinvent the wheel”.

Both Pillay and Broomberg reiterated that medical schemes would still have a role to play, by paying for any services not provided for under the NHI.

For example, Pillay clarified that if a patient chose to ignore the NHI provisions and directly consulted with a specialist doctor, this could then be claimed for from a medical aid scheme.

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