NHI won’t have immediate impact on medical aid

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The National Health Insurance (NHI) is unlikely to have much of an immediate effect on medical aid schemes or even public hospital care, according to various experts in the health sector. However, it does raise very concerning key issues about the state of healthcare in South Africa.
by MIRAH LANGER | Jul 12, 2018

As for changes to medical aid schemes, Dr Jonathan Broomberg, the CEO of Discovery Health, told the SA Jewish Report this week: “As we read the legislation now, it seems that very little will change in the short- to medium-term future.

“[Once the NHI is implemented], if you are able to afford a medical aid scheme, you will still be able to remain a member and to get all of the healthcare services that you require covered by your medical aid, as you do today.”

He said medical aid members shouldn’t worry about paying twice if compulsory payments to the NHI were enforced by government, as the truth is, they already are. “In reality, members are already paying twice – once through taxes that fund a significant part of the public healthcare system, and a second time for medical scheme premiums,” Broomberg said. “This situation is very similar to the situation for citizens who pay taxes, and then pay again for private schooling, security, etc.”

He said that if new taxes are introduced for the NHI, these are likely to be quite far in the future and at a very low level, as the economy cannot sustain the impact of material tax increases.

“Our economy does not have the capacity to materially increase either personal or corporate tax rates, and there are also many other priorities for government tax revenue.”

The SA Jewish Report spoke to Professor Martin Smith, the academic head of surgery at the University of the Witwatersrand and the clinical head at Chris Hani Baragwanath Hospital, as well as to Dr Michael Klipin, who serves as chairperson of the Association of Surgeons of South Africa. Both spoke in their personal capacities.

Klipin supports the theory behind the idea of the NHI, saying that “ideologically, every country should have a catch net of healthcare that it can afford”. However, he remains concerned about its long-term success.

Smith, too, said that his “first impression is of being completely in support of the concept of some kind of national health insurance, which will enable universal health coverage”. Yet he remained apprehensive. “The question is not so much about the principles as it is about the ability to implement.”

In particular, funding of the NHI was a concern, he added, especially as there appears to be a lack of detail in the bill on how money for the fund would be raised.

Furthermore, said Klipin, a key concern was over how a new fund of money would be administered. “The major concern about the NHI as a funding model is: Do we really want a really huge stash of cash for the government to administer?”

Beyond funding and logistics there were also political considerations, said Klipin: “The big concern regarding the NHI is: Is there the political will in government to run a healthcare system and not a political franchise?”

When it comes to public hospital care, Smith did not believe this sector could offer better care through the NHI as its current problems were not just about funding. “The quality, the dysfunctionality, the corruption, the theft, the poor management makes it impossible for us to implement across the board some form of NHI. Until you fix the system, pouring more money into it – to take money from the national fiscus to pour into a dysfunctional system – you may as well burn it.”

Health Minister Aaron Motsoaledi told the media in Pretoria on 21 June that the plan was to implement the NHI “in a phased-in approach”, with an immediate focus on primary health care.

During the last budget, R4.1 billion was allocated to the NHI programme and this would be used for primary healthcare projects.

Motsoaledi said the focus areas would be on school health, mental health, assisting pregnant women facing complications in 22 highly affected hospitals, and assisting with oncological care – especially in Gauteng and KwaZulu-Natal.

He explained that the health department had already screened 3.5 million schoolchildren, “testing to find their needs in terms of physical barriers to learning, be they to do with eyesight, hearing, oral health and speech”.

Motsoaledi said about a third of students from the poorest schools were found to have at least one of these four problems – and would now be assisted.

In preparing for the NHI, the government was assessing how private service providers could be incorporated to provide care in the public sector: “Here we were testing how private GPs can be integrated into the healthcare system to provide services… For HIV and Aids, we are going to decant 50 000 patients to be under the care of GPs,” said the minister.

Smith told the SA Jewish Report that he welcomed this focus area: “The NHI can make a difference to primary healthcare. If we can improve the base of the health sector, then I think everything else will follow.”

Both Smith and Klipin agreed that the issues that the NHI raised about health care in South Africa were also a reminder that the private sector, too, had significant problems.

Motsoaledi addressed this during his media briefing, saying the “existing cost of private healthcare” and the “poor quality of care in the public health system” were the “terrible twins of the healthcare system”.

Said Smith: “The private sector is a resource that certainly needs to be changed.” However, he did not think “that trying to force the NHI on that system is going to bring them in line”.

He said: “I think other ways need to be put in place.”

Klipin reiterated this stance, saying the public sector had “service delivery and financial constraints”. On the other hand, he said, in the private sector, issues centred on “cost containment and sustainability from a cost point of view”.

He concluded: “There are significant problems in both; different problems but significant.”


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