South Africa should follow popular global model in introducing NHI: association

The Health Funders Association (HFA) has presented its position on the NHI Bill of 2019 to the Parliamentary Portfolio Committee on Health. 

In its presentation, the HFA pledges support for Universal Health Coverage (UHC) for all South Africans and commits to contributing constructively to strengthening and building a sustainable and integrated health system for the country.

The industry body, representing 50% of total medical scheme principal members, emphasises the urgency of achieving UHC, given the country’s level of economic development, poor health outcomes relative to economic peers, and its complex and shifting burden of disease.

Lerato Mosiah, chief executive of HFA, said that considering the already fiscally constrained environment and the global recession brought about by the Covid-19 pandemic, an incremental approach to achieving sustainable UHC provides a more manageable increase in expenditure over time while balancing other national priorities.

Mosiah added that rather than implement NHI as a single-payer system as proposed in the bill, consideration should be given to utilising elements of the existing health system to provide access to quality healthcare for all South Africans. 

“This approach is followed by many health systems globally where established private health systems already exist,” she said. 

The HFA called on the government to use the establishment of the NHI framework to implement the reforms necessary for integrating medical schemes into the NHI rather than limiting their role, as this will adversely affect access and cost of cover.

“Restricting the role that medical schemes can play will place a greater burden on the public sector and mean a much narrower range of services than is currently provided by medical schemes. Curtailing the ability of medical schemes to pay for services creates significant uncertainty amongst service providers and may discourage them from practising in South Africa,” said Mosiah.

The association suggests that a single-payer system with monopsony buying power will not lower prices and may threaten the equilibrium of demand and supply of services.

“A single-payer system disincentivises research and development, which often requires significant financial investment, and discourages investment and innovation in healthcare provision,” said Mosiah.

The HFA suggests that a multi-payer system in which a risk adjustment mechanism establishes virtual risk pools would be preferable as it would avoid the pitfalls of a single-payer system.  

“We believe that medical schemes have the necessary expertise and infrastructure to participate in achieving sustainable UHC in South Africa and urge the government to make provision for this in UHC legislation,” said Mosiah.

Read: Doctors plan to leave South Africa because of the NHI

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South Africa should follow popular global model in introducing NHI: association