Africa-Press – South-Africa. The National Health Insurance (NHI) Bill, in its current form, needs urgent amendments before it can be passed.
This was the sentiment from several concerned healthcare groups and medical schemes who took part in the Cape Town leg of the public hearings into the NHI Bill, which kicked off last Friday in the Western Cape legislature.
Introducing the NHI Bill in the Western Cape legislature, the National health department’s Advocate Micro Moabelo, gave MPLs an overview of the bill.
Gary Feldman, representing the Financial Intermediary Association of SA, was the first to highlight his concerns saying the bill should not be centralised.
“We do support the goal of expanded universal health care, that is what we do believe is the right of every South African public member, and ultimately we believe that it is important that there is rework of the medical environment in SA,” Feldman said.
“We believe that it should be ward-based primary health care that each region and province can then determine what is needed and how to allocate resources at ground level.”
But Feldman warned that the barriers of universal health care in South Africa are many, while the funding and resourcing of the universal healthcare and national bill is a concern.
“The funding is a challenge that has been raised by the national minister of finance quite recently and does concern us as an organisation. We believe that to roll out universal health care we require a collective effort with sound policy decisions, and not just one size fits all,” he said.
Feldman said they see private health care as a national asset, adding that they also don’t believe the private health care environment is sustainable in its current form or environment and needs to be reworked as well. “People have a choice of the different forms of insurance available to them,” he said adding that the system should offer choice.
Feldman warned that they are concerned that the bill in its current form could be subject to several court challenges.
He said:
The risk of a lengthy court battle cannot be underestimated, he added.
And the Association proposed that the current bill be amended as a precautionary measure but also as a step to looking at the future growth of health care in South Africa.
“We propose a solution that is to focus on amendments of the bill and there’s certain elements that need to be reviewed,” he said.
Momentum Metropolitan Health Solutions’s Dr Boshoff Steenekamp said the introduction of the bill will see a reduction of the provincial health budgets by 28%.
“That will weaken the provincial legislatures as well as weaken the provincial health departments; all health care purchasing decisions will no longer be taken at a provincial level but will be made by the NHI fund,” he warned.
Steenekamp added that the reduction in funding for the provincial public sector could destroy it.
“This will be another blow on top of the current budget cuts,” he warned.
“Pilots must be done before these funds are withdrawn from the provincial budget allocation. These pilots must show that it’s feasible for a central fund to purchase equitable, quality and affordable health care for the population across all provinces,” he stressed adding that he is particularly concerned about the rural poor.
He said the bill must be amended to allow for a systematically planned gradual implementation so that we only implement what we have tested and found to be working.
Business Unity South Africa (Busa) board member, Stavros Nicolaou said they were in support of the NHI Bill but like the other speakers, they have some concerns that a single fund approach is unworkable and will exacerbate rather than reduce the health inequality in the country.
“We have proposed a few critical changes to the bill in order to allow for both the private sector to support the NHI in a collaborative effort with the public sector,” Nicolaou added, saying the county is at its best when the private and public sector works together.
The Board of Healthcare Funders (BHF) said they support the concept of universal health coverage but they do not support the NHI bill in its current form.
Bronwyn Macauley, the health care services manager at Clicks retailers, said they are in support of what the NHI wishes to achieve.
“We are committed to enhancing access to health care services as we have the workforce and infrastructure,” she said.
Mediclinic Private Hospital’s Clara Findley said they are fully in support of universal health coverage and have been involved in studying the bill and participating in every single phase of the development of the proposed legislation.
“There are however serious concerns with the bill and we would like to address those concerns… but we do believe there are mechanisms to fix it,” she said.
Mediclinic highlighted their main concerns as all being constitutional, adding that they however are fully committed to engaging with government to make the bill work.
Damaris Kiewiets, the Chairperson of the Cape Metropolitan Health Forum told the legislature that the current dysfunctionality of the health system must be fixed first where clients are not being cared for in the manner that they should be.
“Whether you’re in Timbuktu or in Blaauwberg… if anything happens to you, you will be able to access any health care, anywhere in the country.”
“We agree with the National Health Insurance for everyone. Universal health coverage does not matter what colour you are, if my R6 000 that I currently pay for health cover can go into the universal health cover so be it.”
And she stressed that health care is not a privilege but a constitutional obligation.
Several NGOs and medical schemes also vehemently opposed the proposed bill.
The bill is currently with the National Council of Provinces (NCOP) after the National Assembly passed it in June, despite strong opposition from the private health care industry and opposition parties.
The NHI will create a single fund to which those earning an income will contribute, probably through a payroll tax.
The Western Cape Government has been vocal about its stance on the NHI Bill.
MEC Nomafrench Mbombo in July said the country needs Universal Health Coverage (UHC), which means free health care for everyone.
“NHI is a money bill; it doesn’t say anything about UHC,” she said at the time.
Public hearings in the Western Cape in all six district municipalities are running from 18 to 27 September.
For More News And Analysis About South-Africa Follow Africa-Press
