Africa-Press – South-Africa. While disparate role players in SA’s healthcare sector agree on major reforms and a right of people to access services, there is profound disagreement on the role of the private sector and medical aids in the future of the National Health Insurance (NHI) scheme.
This is according to research and interviews conducted by Section 27 and consultancy Concentric Alliance with numerous stakeholders on how to work together to fix the “fatal” stagnation in the healthcare sector. A report on the findings highlighted that people were interviewed from the national and provincial departments of health, health regulators, medical schemes, public and private health care workers, trade unions and private hospital groups, among others.
Their report found that the role of the private sector is one of the most contentious aspects of health reform in South Africa, particularly around medical schemes.
“The private health sector contributes significantly to the South African economy, is a large employer and many respondents in both the public and the private sector believe could be an important role player in health reform, having significant excess capacity and resources available,” the report found.
The crux of the major disagreement is around Section 33 of the NHI Bill, which states that medical schemes may only provide cover that “constitutes complementary or top up cover and that does not overlap with the personal health care service benefits purchased by the National Health Insurance Fund on behalf of users”.
Gap or top-up cover provides for the shortfall when doctors and specialists charge above normal medical aid rates of cover.
A hill to die on
The report said that this ultimately meant that “private medical schemes that are not gap cover, will cease to operate, with members covered by those schemes being required to use the NHI.” This was the cause of “significant disagreement” between the private sector and the national department of health.
“Unsurprisingly, all respondents from the private sector have argued that even in countries with the most developed and extensive public health services there still exist private healthcare funders,” the report said.
“Additionally, an academic argued that it would better to incentivise people into abandoning private funders by establishing a reliable and well-functioning public funder, rather than threatening to remove a functioning service.”
One private sector participant said the NHI said Section 33 would constrain competition and limit the efficiency of the NHI.
Health minister on NHI: Medical aids to still cover specialists, hospital visits – initially
Submissions on the bill raised concerns about the transition to NHI and how “without careful forethought this section will result in many additional users moving into an already overburdened public sector, without the necessary strengthening of the public sector”.
It said that for some stakeholders Section 22 has become “something of a hill to die on.”
“During the six-a-side engagements between Business Unity SA and the national department of health [NDOH], urgent discussions on NHI were nearly derailed by demands that Section 33 be re-opened for discussion and one respondent in the NDOH stated that the bill was now before parliament and these issues would be addressed during public consultations.
“This respondent stated that they would rather see this point litigated, than back down.”
The report found that the current approach to this draft provision has the potential to undermine the implementation of the NHI and delay urgent reform to the health system.
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