How rare and expensive medicine and medical issues will be covered under the NHI

Despite an 8.5% GDP spend on health care, South Africa is among the worst-performing countries in the world regarding health outcomes, says Dr Nicholas Crisp: deputy director-general of the National Health Insurance (NHI).

Speaking on a recent panel about rare diseases, Crisp said that all healthcare providers, public and private, should be accessible to everybody purely based on their healthcare needs.

“The NHI is a financing mechanism that intends to change the structure of delivery of the healthcare system in a slow and sequenced manner, to attain universal health coverage where no payment is required of any patient at the point of service delivery,” he said.

Crisp said that rare diseases are currently treated in the public sector. However, there are obvious limitations of capping of care and rationing of services, which happens even in wealthy countries.

“The NHI fund will enable efficiencies that can redirect more money to pay for rare disease products, although there may be a point where it is not cost-effective for the individual or the nation.

“Inclusion will be based on the cost-effectiveness of the health product rather than which health product is the least expensive.”

Crisp said that there are other advantages of the NHI fund as a single purchaser. “Over time, the artificial intelligence in the system makes it possible for us to understand where the products are being used, by whom, are there variations, and what is rarely used?

“This enables budget accommodations to be made, particularly in the case of rare diseases, so that the other people living in that area are not penalised for those few who are receiving very expensive care.”

Doctors not convinced

While the government remains gung-ho on the introduction of the NHI, the country’s medical professionals are less convinced by the scheme, data published by Trade union Solidarity in August shows.

The survey drew a response from 1,410 healthcare workers in three separate studies conducted in 2018, 2019 and 2021.

Across the studies, the overarching response from healthcare professionals is one of uncertainty and mistrust around the NHI, with general sentiment towards the system being overwhelmingly negative.

“Almost all the respondents have serious concerns regarding the state’s ability to manage and administer the NHI,” Solidarity said. “The total administration and management of funds and decision-making will be in the hands of the state.

“Most are seriously concerned about the fact that the state can determine and enforce tariffs, place of work, type of diagnostic tests and type of medication and treatment.”

Solidarity said that the observed mismanagement and maladministration at institutions such as Eskom, the SAA and the SABC likely shape respondents’ opinions.

The NHI will be significantly larger and more complex than these groups, must serve a population of more than 55 million people, and will have to manage and execute many contracts, it said.

When asked whether they are already taking steps to emigrate because of the NHI plans, 13.7% of the respondents said they have already started the emigration process.

However, once the NHI is in effect, the number of healthcare workers intending on leaving the country increases to over a third (35.9%). By contrast, only 15.3% of healthcare workers are confident they will stick around once the NHI is fully effective.

Read: 4 taxes that could fund South Africa’s NHI – including 20% VAT

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How rare and expensive medicine and medical issues will be covered under the NHI