The National Health Insurance (NHI) bill has passed parliament, but experts say the bill is largely “impossible” and unlikely to come into force soon.
Alex van der Heber, head of the administration of the social security system at the University of the Witwatersrand, said: [the governing ANC] They were in a predicament where they could either try to fix the framework in parliament or give the Ministry of Health the ball and ask for a reconsideration, which would be very embarrassing. “
Financial Advisor Intellidex Managing Director Peter Montalt agrees. He told Newzroom Afrika that the NHI was “logistically impossible” and, given the lack of clear information about funding, it was unlikely to happen in a reasonable time frame.
Earlier this month, Health Minister Joe Faarah, in a vague reference to funding the NHI, said the NHI would be “those who can only contribute financially through indirect means such as VAT and other levies, and those who We aim to pool our resources where possible and contribute.” It already makes fractional contributions to 81 different schemes, from lowest to highest levels of care, combined into one pool where services can be purchased from both public health systems and private providers. “
That sounds like what many in the private sector are saying. The health ministry appears to want high-income people’s contributions to the current private health system to be redirected to public health care through additional taxes.
Van der Heber said the government appeared to be ignoring issues raised by industry players in order to push the unrealistic bill to pass. “This speaks to the weakness of the ability…even when you don’t have the ability…continue regardless.”
Fahara said those who argue the NHI cannot afford to pay “based on hugely inflated costs among some private health care providers who are under pressure to continue to provide super care.” I am giving my opinion,” he said. [sic] profit”.
Let’s see it. Netcare, a private hospital group, recorded revenue of R11.5 billion in the six months to March 2023. Life Healthcare recorded revenues of R10.6 billion across Southern Africa during the same period. Mediclinic does not publish financial statements because it was acquired by Remgro.
I can’t help but think that the minister is referring to the “super profits” claimed by listed private hospitals, not the healthcare system. Because the Minister of Health certainly understands that the health system provides co-benefits to its members and is a non-profit enterprise.
Back to cost. The 2023 budget allocated his R259 billion for health care. Of this, R113 billion goes to district health, R49 billion to central hospitals, R46 billion to ‘other health services’, R40 billion to provincial health, and R11 billion to management and maintenance of facilities.
So the problem is not underfunding the public health sector.
“SA’s spending on health as a percentage of GDP far exceeds that of other developing countries,” van der Heber points out. “We have a problem with governance. Accountability in the framework of governance has been greatly reduced, people are basically systematically stealing money from the state, and they are being held accountable. not.”
The Health Care Funding Board (BHF), which represents all health care schemes except the Discovery Health Medical Scheme, echoed his opinion, stating “concerns about governance structures, operational efficiency, and risk concentration in medical institutions. The single-payer system in a fragile economy characterized by pervasive corruption, and many other concerns raised by state attorneys, are short-sighted and utterly ignoring many who have expressed Not very wise.”
The BHF urged the government to consider a multi-payer model to reduce risk concentration, deploy based on milestones rather than dates, and replace concerns that the proposed NHI would be vulnerable to corruption. It asks for attention by proposing a governance structure for
open issue
Prelisha Singh, a partner at law firm Weber Wenzel, said there are many unresolved questions and concerns about the actual implementation of the NHI despite parliamentary approval.
“Many stakeholders and experts have expressed concerns. [it] It is completely out of reach, especially since it requires a large-scale management mechanism. A related concern is the extent to which the NHI will rely on the public health system to provide services and whether that system will be able to provide an acceptable quality of service.
“Given the dire state of public health care in our country, it is astonishing that the government is so persistent in its plans to expend enormous resources on implementing national health insurance. If implemented, it would greatly improve the delivery of quality health care and access to that care,” she said.
Mr Singh said the bill says the primary source of income will be funds allocated annually by Congress.
“This must be funded from among others general tax revenue, payroll tax and personal income tax levies. But this is difficult to reconcile with another provision that states: [NHI] The fund will provide “compulsory prepayment” (a term defined as “compulsory payment for medical services before they become necessary according to income level”) and the power to lay down regulations on the “obligation to pay all fees” to ministers. Funded through Article 3 that gives Fund’. “
Major issues not addressed include:
- The extent and reimbursement rate of benefits covered by the NHI Fund. Both are important for assessing the impact of NHIs on the provision of affordable and quality care.
- Rules for portability. Allow the patient to be treated by a service provider other than the service provider with whom the patient is registered.
- Referral pathways between service providers.
- Coding system used.and
- The relationship between the fund and the health care system.
The key question, Singh said, is what role the healthcare system will play and whether it will continue to exist. As it stands, the National Health Insurance Bill stipulates that after the Minister determines that the National Health Insurance has been fully implemented, the health system “can only provide supplementary coverage for services that cannot be reimbursed by the fund.” there is He also said patients have the right to “purchase medical services not covered by the fund through complementary voluntary health insurance schemes.”
In other words, the health care system may not be able to cover the services covered by the fund. Since the fund is intended to ultimately cover blanket benefits, the healthcare system will be significantly reduced or eliminated.
Singh added. “This administration is violating the right to access health services by forcing many people who currently access private health care through health system funding to rely on public health care, which is currently woefully inadequate. are likely to face constitutional problems because they are “systems;” the property rights of health care systems and their administrators; and the right to freedom of trade, employment and occupation. “
Another Webber Wentzel partner, Martin Versfeld, said service provider certification requirements were onerous, including submitting a “budget impact analysis,” and there was a lack of clarity about how reimbursement rates were determined. says that
“One would expect the bill to make it clear that payment rates should be set at a level at which providers can efficiently cover their costs and make a reasonable profit. Health-related products must be procured according to the foundation’s formulary, and suppliers listed on the formulary must deliver directly to service providers or facilities, blurring the lines between public and private procurement. , reducing competition and unduly restricting private service providers’ business operations,” he said. DM
