Covid increasing the cost of healthcare for all, and blocking NHI rollout

The Covid-19 pandemic has delayed the implementation of the National Health Insurance bill and it will continue to be a stumbling block for the rollout of the policy across the country as planned.

This is according to Phumelele Makatini, Chief Executive and Principal Officer of The Building and Construction Industry Medical Aid Fund (BCIMA), who said the ongoing pandemic could make the National Health Insurance (NHI) more difficult to implement as well as putting an increased strain on the public purse.

At the same time, Dr Ntuthuko Bhengu, a panel member of the Healthcare Market Inquiry (HMI) at the Competition Commission, says Covid-19 has made healthcare products and services more expensive for the average consumer. The HMI was set up to investigate high prices and alleged non-competitive behaviour in the private healthcare industry.

It released its findings at the public engagement process for the NHI bill in September 2019. It found that the supply side of the healthcare market is severely lacking in regulation, and proposed the establishment of a regulator for this sector.

The pair recently discussed the issue in Makatini’s new podcast Tea with Phumi, where the burning question was whether further regulation of private healthcare business would help or hinder a smooth transition into the NHI.

The NHI Fund is scheduled to be operational by 2026 at the earliest. The private sector is expected to continue to operate in the lead up to the full implementation of the NHI as well as after the Fund’s establishment in 2026.

The Covid-19 pandemic has not only slowed down the law-making process of the NHI, it may make things far more difficult for government to reach its own deadline for the paradigm shifting undertaking.

Also Read: Covid-19 ‘forces rethink on healthcare insurance’

Covid increasing demand and price for certain medicines

Speaking to The Citizen, Makatini says the BCIMA has observed a spike in certain consumer behaviours among its members possibly driving up the prices on certain items, and increasing healthcare expenditure among consumers.

Some stand-out products include prescribed and over-the-counter nutritional supplements, immune boosters, and other flu-related medicines.

“We are seeing higher volumes of claims for medicines relating to coughing and sneezing, which previously we did not see, especially around the summer months and that was not the trend previously. There is also an upward trend in your paracetamols, your headache or pain medicines, which are also linked to Covid-19 symptoms. What is interesting is that our membership base is generally young and healthy. Our average age is around 34 and cold and flu symptoms have not typically been prevalent in this age group especially in the summer months.”

Can we even still afford an NHI?

The question of whether government can still afford to implement the NHI is weighing heavy on its critics, says Bhengu.

“It doesn’t help that the last time any financial projections were seen were the first time the idea was floated, and that was around 2012. Now its absolutely true that Covid-19 has certainly made everything relatively unaffordable, including healthcare, but the WHO (World Health Organisation) will say no country can afford not to have universal healthcare coverage, or in our terms, the NHI.”

Makatini adds that increased government expenditure as a result of Covid-19 may delay certain aspects of implementing the NHI.

Finance Minister Tito Mboweni’s mid-term budget speech this year included the massive reallocation of funds from the National Treasury towards fighting the pandemic, which Makatini suspects involved massive cuts to the funds meant to drive implementation of the NHI.

Bhengu opines that funding the NHI needn’t only come from those who will directly benefit from it. Those choosing to use private healthcare should still be able to contribute to the NHI, which would benefit the entire sector.

“Its important to stress that I am not suggesting that people mustn’t necessarily contribute, but the option to still use private sector after contributing, I just don’t see where that would be a disadvantage to government. If anything you have 9 million people who have contributed to the public sector but choose not to use it – it can only be an advantage.”

Also Read: NHI likely to fail, say experts

NHI shouldn’t mean the end of medical aids

The founding principles of the NHI are that of every citizen having access to quality healthcare. That this should come at no cost at the time of seeking care and that necessity, not affordability should be the main factor in whether or not one receives care.

Bhengu says while these principles cannot be faulted, this doesn’t mean that medical aid schemes should be scrapped. The WHO advised that countries build universal medical coverage onto existing systems rather than scrapping entire industries, he adds.

“We have a very competitive and competent medical scheme industry and we should build on it otherwise we wouldn’t have this industry that is exporting its expertise. Globally South African companies are leading some aspects of health funding and it would be a shame if we cannot use that at least as backup.

“Certainly the first instance, my view is that instead of shutting down the industry, you would rather build the public sector to be so good that people choose not to use the medical schemes industry or the private sector simply because the public sector is so good”.