Snubbed doctors’ body urges MPs to think again about NHI

SA’s biggest doctor organisation has submitted a petition to the National Council of Provinces (NCOP), calling on MPs to revise the National Health Insurance (NHI) Bill.

The bill was passed by the National Assembly in June and proposes sweeping reforms to the healthcare sector aimed at achieving universal health coverage. Critics say its provisions, which include scrapping medical schemes and creating a central fund that will pay for all health services, are unworkable and risk making things worse for citizens.

SA has a deeply inequitable health system, which sees the almost 9-million people covered by medical schemes able to access private healthcare and the rest of the population depending on patchy public services or paying out of pocket for private care. NHI aims to pool funding to ensure everyone has access to healthcare services that are free at the point of delivery, but exactly how it will be financed has yet to be determined. A fact sheet released by the government in June says new taxes will be required, such as a payroll tax and a surcharge on taxable income, but does not set out the level at which they will be pegged.

The SA Medical Association (Sama) has sent a written submission to NCOP chair Amos Masondo, along with a petition signed by more than 52,000 people, urging MPs to reconsider the bill’s provisions.

“The reason we have written the petition is [that] we have been ignored since the discussions on the green paper,” Sama chair Mvuyisi Mzukwa said. “We have been making submissions, but there has never been any consultation or feedback.”

The NHI bill was preceded by two policy documents: a green paper published in August 2011 and a white paper published in December 2015.

The public consultation processes undertaken by the government and parliament to date have been mere tick-box exercises, Mzukwa said.

Opposition to the bill stretches beyond healthcare workers, as evidenced by the signatories

to the petition, he said. “It is also communities. People don’t trust the government.”

The government’s poor track record in service delivery has left communities sceptical about its assurances that NHI will provide better healthcare.

“I was born in Flagstaff in the Eastern Cape. In my village there is still no water; it was promised in 1994. Now the government tells them it will give them a healthcare service under NHI. Yet there is not even a clinic. Communities there say there is no truth to this thing,” Mzukwa said.

Sama’s key concerns about the bill are the risks of corruption, its failure to deal with human resource shortages and infrastructure problems in the public healthcare system, its limitations on the role of medical schemes, and the lack of a cost assessment, Sama said in its letter to Masondo.

“As the final house of parliament that will decide on the adoption of the bill before it is signed into law, we implore the NCOP to consider the concerns raised in this submission.”

The NHI Bill requires consideration by both houses of parliament before it is submitted to the president for assent.