Medical aids in the firing line amid calls for all reserves and assets to be handed to the NHI

The Health Professions Council (HPCSA) says that South Africa’s new National Health Insurance (NHI) should be the only funding mechanism for health in South Africa – and laws should be changed to reflect that.

HPCSA president, professor Simon Nemutandani, told parliament on Tuesday (18 May) that while the body accepts that private medical aid schemes can continue to exist in South Africa – this should only be under condition that they are funded separately over and above tax paid for the NHI.

The NHI should be funded through taxes paid by all employed South Africans, he said.

“For the NHI to succeed, health must be an exclusive national competence – and any sections of the Constitution that militate against this view must be amended,” the group said.

“The Medical Schemes Act must also be amended to ensure alignment with the NHI. NHI should be about funding and contracting, while service provision is left to other entities – public and private.”

Nemutandani said that the NHI Bill must repeal the Medical Schemes Act in its entirety, as it would have no place in the nationalised, centralised funding for health.

Those seeking additional insurance for health cover would then apply for cover under the Insurance Act. Medical schemes should also only offer complementary coverage to services not covered by the NHI, he said.

The HPCSA president said that the current reserves of medical schemes and all other assets under their control should be transferred to the NHI. Medical scheme reserves in South Africa are estimated to be more than R90 billion.

“It should be clear that the (NHI) replaces all funding mechanisms for health,” Nemutandani said. “It must also be clear that the NHI is taking over from the medical schemes, and that all assets under the control of the medical schemes must be taken by over the NHI.”

The HPCSA, together with the 12 professional boards under its ambit, is a statutory body established to provide for control over the education, training and registration for practising of health professions registered under the Health Professions Act.

The NHI Bill was presented to and approved by cabinet in July 2019, and has been presented to parliament’s health portfolio committee.

It has since been subjected to an extensive public consultation process through committee roadshows and is scheduled for further parliamentary debates before it is presented to the president for promulgation.

At the start of May, the Council for Medical Schemes (CMS) said that the government’s planned National Health Insurance is in full development, with plans to move to phase 3 of the programme from next year.

In its 2021/2022 annual performance plan, the CMS said that phase 3 will include mandatory pre-payment of the new scheme, contracting for accredited private hospital and specialist services, and finalisation and implementation of the NHI Act.

“This (current) period coincides with the beginning of the second phase of the implementation of the NHI,” the CMS said.

“The CMS sees its role as playing both a supportive and a direct role in the delivery of all the activities according to the Act that should occur in the private sector.”


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Medical aids in the firing line amid calls for all reserves and assets to be handed to the NHI