Specialists oppose NHI as unviable

SA’s industry association for medical specialists — the SA Private Practitioners Forum — says it does not support the National Health Insurance Bill (NHI), describing it as financially unviable and at odds with the rights of people to choose how and where they wish to obtain healthcare.

SA’s key industry association for medical specialists says it does not support the National Health Insurance Bill (NHI), describing it as financially unviable and at odds with the rights of people to choose how and where they obtain healthcare.

The SA Private Practitioners Forum (SAPPF) raised concern about the sustainability of the private healthcare sector if, as the bill states, the role of medical schemes is curtailed sharply. The forum’s concern about the bill’s potential effects echo that stated this week by the country’s biggest doctor organisation, the SA Medical Association (Sama).

The bill is the first piece of enabling legislation for NHI, the government’s plan for universal health coverage, and was approved by parliament’s portfolio committee on health last week without any material changes to the version MPs received in 2019. It will now go to the National Assembly for debate, where it is expected to be approved. Then it will have to be considered by the National Council of Provinces and sent to the president for assent. While the bill still has some way to go before enactment, its approval by the committee nevertheless marks a key milestone.

The forum said the “very minor” changes made to the bill failed to address any issues of concern raised by private healthcare practitioners and would not change its effect on the delivery of private healthcare. Section 33 of the bill pares back the role of medical schemes sharply, limiting them to providing only complementary cover to services that are not covered by the NHI Fund.

The bill provides for the fund’s establishment as the sole purchaser of health services.

Business Unity SA and SA’s biggest medical scheme administrator, Discovery Health, lobbied for the legislation to allow multiple purchasers of health services, and thus provide a lifeline for medical schemes.

“Limiting the capacity of medical schemes to fund healthcare reduces the opportunity to improve access to, and infringes on the rights of people to make choices about how and where they access healthcare,” the forum said in a statement to its members on Thursday.

“The private sector has tools and resources that are able to increase access to care by contracting with the state. To achieve this and be sustainable, the private sector must be able to run independently with free choice of patients,” it said.

The forum said the bill’s purchasing model would have an immeasurably negative effect on the fiscus, “at a time when the economic climate in SA is dismal, corruption in every sphere including healthcare is constantly being uncovered, load-shedding is crippling the economy and national infrastructure is crumbling. To proceed with its introduction at this time is irresponsible,” said the forum.

Sama said at the weekend that the bill had been developed without regard for the concern and recommendations of experts. In its current form, it set the health system up for failure.

Sama said that it supported the principle of universal health coverage but did not believe the bill would achieve that goal.