Phaahla says NHI will be delivered step by step

• Concern about constitutionality of provisions in the bill

The government plans to implement National Health Insurance (NHI) incrementally and gradually phase out the role medical schemes play in funding private health-care services, health minister Joe Phaahla told delegates at a virtual event on Tuesday. “NHI is not going to be something that happens at a go, at full blast,” he said. “Medical schemes will continue to cover those aspects that NHI is not covering at the introductory level,” he said.

The government plans to implement National Health Insurance (NHI) incrementally and gradually phase out the role medical schemes play in funding private health-care services, health minister Joe Phaahla told delegates at a virtual event hosted by medical scheme administrator Momentum Health Solutions on Tuesday.

“NHI is not going to be something that happens at [one] go, at full blast,” he said on Tuesday.

“Medical schemes will continue to cover those aspects that NHI is not covering at the introductory level,” he said.

NHI is the government’s plan for universal health coverage and aims to ensure everyone has access to health services that are free at the point of delivery. It aims to pool finances in a central fund that will buy services on behalf of the population, with the rich and healthy subsidising the poor and sick.

The first piece of enabling legislation, the NHI bill, is now before parliament. If they approve the bill, it will be referred to the National Council of Provinces for concurrence.

Phaahla’s comments, which are consistent with remarks he made to parliament in its recent public hearings on the NHI bill, are likely to provide some comfort to the R219bn medical scheme industry, as they signal a continued role for funders for at least several years to come.

The role of medical schemes is one of the most contentious and ambiguous aspects of the bill. On the one hand, section 33 says when NHI is “fully implemented”, medical schemes will not be allowed to provide cover for services reimbursable by the NHI. But, section 8 says people who choose their own healthcare providers instead of using the NHI “referral pathway” will not be funded by the NHI, but will be able to claim from medical schemes or health insurers.

Momentum Health Solutions chief marketing officer Damian McHugh said there appeared to have been a welcome shift in the government’s view on how to implement NHI, away from a big-bang approach. It could take years, perhaps as long as a decade, for NHI to complete the implementation of primary healthcare cover, he said.

During this time, medical schemes would continue to provide cover for secondary and tertiary services.

Primary health-care services include visits to GPs, dentists and opticians, but generally exclude more specialised and hospital-based care. “I was very encouraged [by the minister’s remarks]. I think many of us had thought the industry would be gone in two to three years,” McHugh said in an interview.

Last month, delegates to the Board of Healthcare Funders annual conference heard that more than two-thirds of the parties submitting comments on the bill raised concern about the constitutionality of the provisions that make it unlawful for people to purchase health-care services that are covered by the NHI fund.

Vishal Brijlal, a senior director at the global health organisation the Clinton Health Access Initiative who presented an analysis of submissions on the bill, at the time said was at odds with the bill of rights.