Keep medical aids under NHI — Busa

• Business body lobbies government

Business Unity SA (Busa) is lobbying the government to allow medical schemes to continue operating under National Health Insurance (NHI), as this will ensure the private healthcare sector remains viable and reduces the load on public health facilities.

Business Unity SA (Busa) is lobbying the government to allow medical schemes to continue operating under National Health Insurance (NHI), arguing this will ensure the private healthcare sector remains viable and reduce the load on public health facilities.

It made its case at the second presidential health summit, a high-level meeting aimed at improving care provided to patients across the spectrum.

The two-day closed meeting is focusing on NHI, the government’s proposed reforms for achieving universal health coverage. The National Health Insurance bill now before parliament provides for the establishment of a central NHI fund that will pay for healthcare services procured from the public and private sector, and limiting the role of medical schemes.

“What we are proposing is some flexibility to section 33 of the bill, to enable a multipayer, multiprovider system,” Busa executive Stavros Nicolaou told Business Day after presenting the organisation’s position to the summit. “This is not a selfish request to maintain the status quo. We would not want anything in the bill that weakens either the public or private sector,” he said.

Busa acknowledged there were problems with the private healthcare sector, and suggested the government implement the recommendations of the Competition Commission’s health market inquiry, he said.

Section 33 of the bill says that once NHI is fully implemented, medical schemes may provide only complementary cover for services not covered by the fund.

Busa supported reforms to widen medical scheme membership to employed people who could not afford cover, which could be achieved with the low-cost benefit option framework being developed by the Council for Medical Schemes, he said. This had the potential to reduce the burden on public health facilities, which are struggling to provide services in the face of a growing population, an increasing burden of disease, and budget cuts.

President Cyril Ramaphosa’s special adviser on social policy, Olive Shisana, urged the government to speed up its work on new procurement laws, saying it would help deal with the “policy misalignment” that recently saw state-backed vaccine manufacturer Biovac lose a key contract to a rival importing the goods from India.

“It would be good if [the government] could expedite the Public Procurement Bill ... and purchase local products even if they come at a premium, because in the end it will benefit the country and the economy,” she told summit delegates.

The health department took other government entities by surprise in April, when it awarded a pneumonia vaccine contract to the local subsidiary of Indian generic manufacturer Cipla, which will import the shots from the Serum Institute of India. Biovac entered into a partnership with Pfizer several years ago to bottle its pneumonia vaccine at its facility in Pinelands, Cape Town.

Both parties made investments in the expectation that Biovac would supply the state.

The two health summits convened by Ramaphosa highlight the importance he has attached to fixing the problems confronting the sector. High unemployment rates means medical scheme membership remains out of reach for most people, leaving the rest largely dependent on the state: only 8.95million people could afford premiums in 2021, out of a population of about 60-million, according to the Council for Medical Schemes.

While many uninsured patients pay out of pocket for private-sector primary healthcare services such as GP and dentist visits, the majority of the population depends entirely on the crumbling public health system to cover their needs.

This week’s meeting aims to revive the work of the first summit, held in October 2018, which concluded with a promise to fix the public health system’s problems by the end of that year and speed up work on NHI.

Shisana said NHI aimed to correct the inequities in SA’s two-tier health system, and pool resources so that all South Africans had access to quality health services that are free at the point of delivery.

She called on the private sector, labour and civil society to collaborate with the government to improve SA’s health services, saying the government could not do it alone.

Health minister Joe Phaahla acknowledged the problems affecting the quality of care provided in the public healthcare sector, saying the challenges went beyond budget constraints. “Millions of people receive acceptable services in many public health facilities (and) there are even pockets of excellence. But ... these pockets of excellence are drowned out by the negative experiences that people have,” he said.

“Many of our public health facilities could perform better if it was not for inefficiency, poor management, neglect of duty due to poor supervision and unfortunately even outright corruption,” Phaahla said.