‘Too soon’ to call the NHI corrupt: government

 ·17 Dec 2023

The health department’s deputy director-general for National Health Insurance (NHI), Nicholas Crisp, says that it’s premature to criticise the scheme and the government’s plans to set it up, adding that the negative response to the plan is “unfair”.

The controversial NHI Bill was recently passed by the National Council of Provinces and sent on to President Cyril Ramaphosa to be signed into law. The bill will establish the NHI Fund and lay the foundation for the entire scheme to be set up.

The new laws have been met with fierce backlash from the private healthcare sector, with many professionals, business groups, medical aids and other key stakeholders feeling completely ignored in the process – especially given that the bill would effectively cement the end of private health insurance and hamstring private hospitals and practices.

One of the most controversial aspects of the bill, however, is what is left unsaid: the laws set up the NHI Fund, but give no indication of how it will be funded, and promise “comprehensive” health coverage, but zero indication of what that actually means.

On the funding side, the Department of Health has already hit back at critics of the bill, saying that taxes will be hiked to raise funds – but the bill’s opponents are warning that giving the government access to billions of rands of additional taxes and rerouted funds from the budget will open the floodgates for corruption, as has been the case with almost every other government entity with big budgets.

Speaking to the Sunday Times, however, Crisp said that health sector entities tend to be the exception to this, noting that entities such as the South African Medical Research Council and the South African Health Products Regulatory Authority were run competently and successfully – so to label the NHI as corrupt or a failure before it even has the chance to launch is unfair.

“To criticise an agency that has not yet been established, let alone operationalised, is definitely premature,” he said.

He said the NHI Fund will be run transparently and efficiently. He also said that most issues raised about the NHI are premature because the regulations – which are still being drafted and will be published much later, after the NHI Fund and foundational laws have already been put into effect – will detail what happens next.

These regulations will have to be published for three months and go through the standard public comment and participation processes.

Notably, the ANC-led majority in the portfolio committee, National Assembly and NCOP pushed the NHI Bill forward – even against feedback and proposed changes from the private sector and even the health department itself – so this will be little comfort to those who stand opposed to the bill.

As the defacto “showrunner” of the NHI in the health department, Crisp has long pushed back against the scheme’s critics, defending the bill every step of the way.

Earlier this year, he took a similar stance on warnings of corruption, saying that the NHI could become a government-owned scheme that is as effective as SARS rather than something as messy as Transnet or Eskom.

He has maintained that critics of the scheme are fighting against a process that will take years, if not decades, to fully implement and fully realise, applying concerns about healthcare today to solutions that will only be realised in 15 to 30 years.

This timeframe has also been acknowledged in the private sector, with Discovery Health CEO Adrian Gore also pointing to a multi-decade implementation of the scheme as some cause for relief to the private sector.

However, it’s exactly this timeline that makes the clause of the NHI Bill that effectively kills medical aids so irrational, he argued this month.

According to Gore, section 33 – which prevents medical aids from offering cover to any services that will be covered by the NHI – makes no sense because it puts a definite, albeit vague, termination date on medical aids sometime in the future, while providing zero certainty what this means for health insurance or private healthcare.

As a result, this will only deter further investment in both, and create further anxiety for healthcare professionals.

The Discovery CEO has appealed to the government to change section 33 of the bill to be more flexible and cooperative with the private health insurance industry.

The health department has not been receptive to this and has instead doubled down on its path, saying no amount of lobbying will change its direction.

Gore is optimistic that the funding reality – ie, the fact that South Africa cannot afford the NHI and can get nowhere near to providing comprehensive health coverage to everyone in the country – will ultimately win out in the end and convince the government to reassess the flawed bill.

Read: Why doctors in South Africa would rather shut their doors than suffer the NHI

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