Warning for South African medical aid users

The National Health Insurance (NHI), a long-promised initiative to provide universal healthcare coverage, is unlikely to fully materialise anytime soon, meaning that South Africans should keep hold of their medical aid.

This is the view of Kevin Aron, the principal officer of Medshield, a prominent South African medical scheme, speaking in a recent interview with Business Talk.

“The reality of the situation is that NHI is not going to be around for a very long time,” said Aron.

The NHI is the ANC’s plan for universal healthcare coverage that was signed into law shortly before the elections in May 2024.

It is a centralised, national insurance fund from which the government will buy healthcare services from healthcare providers in both the public and private sectors.

However, it has proven contentious, particularly regarding concerns about its R1 trillion estimated price tag.

“There needs to be a focus on fixing the public healthcare sector and less of a focus on this obsessiveness about an NHI which actually the country can’t afford and is going to take many years to roll out,” said Aron

At the end of 2024, Health Minister Aaron Motsoaledi revealed in a written Parliamentary response that of the 3,092 public healthcare facilities inspected by the Office of Health Standards Compliance, only 1,226 or 39.65% comply with the legislated standards.

This means that the balance – 1,866 or 60.35% of the facilities – do not comply with these standards and are not ‘NHI-ready’.

The Medshield executive said that this underperformance is a key reason why many South Africans, even some of those struggling financially, choose private medical aid.

Aron argues that the goal should be to get the public sector to offer quality care on par with or better than private healthcare, ensuring that those who cannot afford private medical aid have access to adequate, reliable, and safe medical services.

He also believes that the state of many hospitals is likely to contradict government pronouncements about the plan’s timeline.

It is also wrapped up against separate legal challenges brought separately by Solidarity, the Board of Healthcare Funders, and the South African Private Practitioners Forum.

“NHI is not going to be around for a very long time… most of the public healthcare facilities will not actually meet the accreditation standards that will be set for NHI,” said Aron.

He cautions against prematurely abandoning private medical aid in anticipation of NHI.

“People should not be… reckless and jump off a medical scheme in the expectation that [this] year there’s going to be NHI. It’s not going to happen”.

Health Minister’s view

During a plenary session in the National Assembly in 2024, Motsoaledi dismissed a cost estimate of over R1 trillion for the NHI, labeling it as “mathematical hooliganism” and suggesting that it was intentionally inflated to provoke public opposition.

He asserted that this figure was based on the faulty assumption that all NHI treatments would be conducted in private hospitals.

Motsoaledi said that while NHI aims to “provide quality healthcare,” this does not inherently equate to expensive healthcare and criticised certain charges within the private healthcare sector as excessive.

“The current system is wrong. The patient is pitted against their own doctor,” Motsoaledi said in an interview with Business Day.

“When I was taught medicine, the first thing in an emergency (was) to check the ABCs — airways, breathing, circulation. Now the first thing an ambulance will check is your pocket,” he added.

The minister has also disagreed with the suggestion of low-cost benefit options for medical schemes, saying it would be wrong to provide poor people with less cover than rich people who could afford more generous options.

“What the NHI proposes is that all health facilities, public and private have to be accessible to all South Africans if and when their health needs demand it.

“But this must be done, obviously, in an affordable manner,” said Motsoaledi during oral replies of the National Assembly.

The Minister has set a deadline for regulations to be incorporated and promulgated by April 2025.

Collaboration attempts

Recently, private healthcare CEOs said that the country faces a critical choice regarding its healthcare future: the “high road” of collaboration or the “low road” of legal battles over the NHI.

The “high road,” as advocated by private healthcare CEOs, involves a collaborative partnership between the public and private sectors.

This approach leverages the expertise and resources of private healthcare providers to address the pressing issues plaguing the public system, including underutilized private facilities and long wait times for public patients.

Proponents of the “high road” argue that this collaborative effort could provide a faster and more effective solution to South Africa’s healthcare challenges.

President Cyril Ramaphosa recently asked the country’s biggest business lobby group to submit proposals on its concerns.

“Government remains committed to engaging with all stakeholders in good faith on the process of health-care reform, and to finding workable solutions that will advance quality and affordable health care for all,” the presidency said in a statement at the time.

Read: Government wants to take away people’s medical aid and healthcare choice