South Africa’s biggest medical aids argue for their right to exist under the NHI

 ·18 Jul 2023

Major private medical aids back the objectives of the National Health Insurance Bill (NHI) and the concept of universal healthcare – but take serious issue with the government’s plans and intentions in executing these goals.

The NHI aims to make the state the sole and exclusive purchaser of healthcare services in the country. In theory, this would allow South Africans to get access to healthcare from the registered provider of their choice – in both the public and private sectors – without having to pay.

However, this plan severely limits private healthcare providers – who cannot set their own prices for NHI services – and removes medical aids from the picture, so private services cannot be financed outside the system.

The government maintains that the NHI won’t kill private healthcare, but it has conceded that room for medical aids will be significantly reduced, as these schemes will only be able to exist to fund services not covered by the NHI.

The NHI, meanwhile, plans to eventually cover almost everything except “unnecessary” procedures.

The role of private healthcare and medical aids is emerging as a big sticking point for the NHI, as is the topic of funding – which the state has openly admitted will require more taxes on South Africans.

While private healthcare providers are standing opposed to the NHI, the messaging isn’t one of outright rejection of the concept – but rather a tactful shutting down of the government’s proposed plan of action.

Momentum Health described the purposes of the NHI Bill as “honourable”, noting that health inequality is very drastic in South Africa.

Currently, there are roughly 51 million South Africans that are required to use public healthcare, whereas 9 million people are administered by private companies.

Of these proportions, roughly R4,412 is allocated per person in the public sector, while over R24,444 is spent on a person in the private sector.

However, Momentum said that the government need not kill off private medical systems, and should instead work with them – like allowing medical aids to offer low-cost options.

Momentum suggested that introducing affordable health insurance from the private sector would alleviate pressure on public healthcare facilities, arguing that the private sector doesn’t need to be eliminated to implement the National Health Insurance (NHI) system.

As reported by SABC, Damian McHugh, the head of marketing for the company, believes that there are incremental steps that can be made to improve public health services, “and we think the private sector should own some of those”.

The company said that similar engagement, as seen during the pandemic when private and public sectors came together, is needed for the NHI to be successful.

“If both sectors listen to each other’s expertise and we are able to help one another, I really do believe we can have a system that can benefit everyone,” said McHugh.

Momentum listed the following challenges with the NHI

  • Governance – Balance of power and vulnerability to corruption
  • Funding – additional tax and single funder and payer
  • Role of medical schemes – supplementary cover and challenges relating to the current role of schemes
  • Delivery system – access to quality healthcare and shortage of providers.

Bonitas Medical Fund, the second largest open medical scheme in the country, has also weighed in on NHI.

Lee Callakoppen, the principal officer at the company, said that critics of the NHI often do not object to the concept of Universal Healthcare (UHC) but rather object to the inherent flaws within the bill.

He said it’s important to remember that the right to quality healthcare includes the responsibility and duty to provide it.

“Section 27(1)(a) of the Constitution states: ‘Everyone has the right to have access to healthcare services, including reproductive health care’. What is worrying is the lack of detail around the implementation of this national health blueprint,” said the principal officer.

“Bonitas does not resist the reasoning behind the Bill in principle and agree with the notion that the right of access to quality, healthcare services in South Africa, is currently disproportionate.”

He said that the NHI Bill in its current form is a funding mechanism, not UHC which would actually improve access to healthcare and address the stated imbalances.

“The Bill is still not clear on what will and will not be offered by NHI and the role – if any – private medical aids will play. What is of concern is that the Bill suggests the scrapping of medical aids in its current form and only refers to complementary services,” said Callakoppen.

“What this means is unknown. However, we believe that the only way for the healthcare system to evolve is through interdependent relationships, with public and private healthcare co-existing.”

Read: ‘Absurd’ NHI a vote-farming fantasy: CEO

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