Govt ‘basically saying medical schemes will cease to exist’ when NHI comes into play

The National Health Insurance (NHI) threatens to collapse the private medical sector as we know it.

Medical scheme coverage may be drastically reduced – if the state supplies most services – and medical aids may disappear, resulting in thousand of job losses. The collapse of the sector would also hit confidence in the economy and be a deterrent to local and foreign investment.

Despite the NHI aiming to cover benefits, medical aids may not cover the same benefits which, according to government, will reduce their membership fees.

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Medical aids will remain voluntary for those who choose to contribute, but will only cover benefits that the NHI does not pay for, so they should be significantly cheaper.

According to Discovery Health, “the way they have it laid out at the moment, they’re basically saying that the medical schemes would cease to exist when the NHI comes into play”.

‘Disappointing’

CEO of Discovery Health Dr Ryan Noach said it was disappointing that the meaningful contributions from multiple stakeholders to the draft Bill were effectively disregarded, with the amended version showing little variation from the original draft.

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“We are surprised that both the National Assembly and the parliamentary portfolio committee’s (PPC) approved the largely unchanged amended Bill, despite material concerns raised by almost all the opposition parties at the committee,” Noach said.

“The significant constitutional concerns raised by the parliamentary legal advisor seem to have been ignored.

“The committee elected not to take the opportunity to make amendments to the NHI Bill, which would enhance both the feasibility and effectiveness of the NHI Fund, despite detailed and constructive inputs from stakeholders, with the genuine intention of supporting expanded access to quality care for all South Africans.”

Noach said it was particularly concerning that the inputs of the healthcare professionals, who were essential to the delivery of care, were not being given the appropriate weight and attention in the amendments to the Bill.

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“As a result, it appears highly likely that this Bill will be challenged through various legal avenues, including probably being contested on various constitutional grounds. This is based on stakeholders’ stated intent during the PPC hearings premised on key issues which have been not amended,” he added.

“We recognise the need for simultaneous reform of both the public and private healthcare sectors to achieve this common goal. Discovery Health is ready to contribute towards a blended, multiparty funding model underpinned by a robust NHI.”

HFA rejects NHI Bill in current form

The Health Funders Association (HFA), which represents at least 73% of open medical schemes and 50% of total medical scheme memberships, also rejected the Bill in its current form.

“It perpetuates several tenets which the HFA believes will undermine the quality of healthcare and the objective of moving towards universal health coverage in SA,” HFA’s Maureen Litchfield said.

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“According to the Bill, once the NHI Fund has been fully implemented, medical schemes will only be permitted to offer benefits for services not covered by the NHI.

“HFA believes that adding the nearly nine million lives covered by medical schemes onto an already overburdened and failing public health system would be detrimental to quality of care.

“The input of the parliamentary legal services to the portfolio committee indicates that the limitation on the role of medical schemes would violate the realisation of healthcare access.”

Litchfield said the constitutional implications of the right to access healthcare and freedom of association had not been addressed and believed that limiting the role of medical schemes will have broader implications on the country’s economy.

“It could have a negative impact on investor confidence. Healthcare access is a key consideration for investment in South Africa and for South African employers,” she added.

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“It will detract from investment into the healthcare system which would benefit the NHI Fund.”

The Council for Medical Schemes’ Stephen Monamodi said they cannot comment because “government still has to decide what our role is”. Medical aid brokers will also be hit.

Valuable income stream

Goudvis & Associates owner Wesley Birch said NHI would take away a valuable income stream.

“We can currently earn R115, excluding VAT, per main member per month – if that falls away, it’s a huge income loss, especially brokerages focusing on healthcare in a corporate environment.”

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Birch said people also stand to lose their jobs and corporates close their doors.

“Private healthcare is not going away, in my opinion. There’s a myriad private hospitals and I doubt they will just hand over everything. That’s not going to happen,” he said.

Written by Reitumetse Makwea and Marizka Coetzer

– news@citizen.co.za