/ 21 August 2019

The NHI Bill is ‘not doom and gloom’

Only the rich have unrestricted access to medical care but the state’s ability to deliver universal health is rightly questioned. (Paul Botes)



While there is uncertainty about the role that private medical providers will play when the National Health Insurance Bill (NHI) gets implemented, Sipho Kabane, Chief Executive and Registrar of the Council for Medical Schemes, is certain that its schemes will continue to exist and function.

“The Council for Medical Schemes will continue to regulate all the entities until we get a piece of legislation that says there will no longer be [a need for] schemes, brokers, managed care organisation as well as administrators,” he said.

“For us there’s no major change in terms of mandate — all the schemes will still exist even in the National Health Insurance dispensation,” he added.

The council is a statutory body which provides regulatory supervision of private health financing through medical schemes. The governance of the council is vested in a board appointed by the Minister of Health, consisting of a non-executive chairman, deputy chairman and 13 members.

The Bill, released last Thursday, aims to provide a package of comprehensive health services for free at private and public health facilities as part of its bid to more equitable access to quality healthcare.

Kabane was in a panel discussion on the National Health Insurance Bill, organised by the Mail & Guardian under the theme: National Health Insurance: Implications, challenges and future.

There have been reports that, once the bill is implemented, medical aids will be relegated to providing top-up cover under the NHI — or coverage for procedures or treatment that fall outside government’s package of care.

But Kabane assured those in the room that the scheme will still have a place. He says that it’s important that they change how they have been operating so that they can fit with the new NHI dispensation.

He says discussions about the bill stem from a couple of years ago — therefore, as it stands now, the bill is not new information and what they should focus on is working to co-exist with it.

“This is no new information and it’s something that we should have digesting as early as 2017 and perhaps we need to start looking at how we position ourselves as schemes, administrators or members and even the regulator in terms of how this new role is going to evolve and how we should address ourselves to it.”

Stan Moloabi, chief officer of the Government Employees Medical Schemes said even though there is “uncertainty” the South African healthcare system is not conducive to all of the 58 million polulation and that needs to be changed.

“The is a need for a universal health coverage to be implemented in South Africa and we know the chosen vehicle by our government is the NHI to fund the move to achieving universal healthcare coverage.”

Molabi said being sure about the bill should not be a course of concern: “In everything in life, wherever there is going to be change, people do not know what is going to be the ultimate end point. There is uncertainty and people get worried. So it is normal.

He said government cannot continue doing the same thing because they know there is a problem in terms of how healthcare gets received by the majority of the population and for the healthcare system to be better, change is necessary.

Critics have voiced concerns of whether the NHI will directly benefit people most in need of healthcare.

Russell Rensburg, the director of the Rural Health Advocacy Project said he welcomes the bill, but said it is not without flaws. “I think governance is a significant challenge — and that is an area we can engage heavily and see how we can improve particularly around the minister’s involvement as a regulator, overseer and director.”

Rensburg said there are some positives around what the bill is trying to achieve. “Health is a public good and not a commodity and I think the bill recognises that.”

“Generally, I feel if the bill is implemented correctly, it can change the nature of the way health is delivered in South Africa — so that all people can access good healthcare.”

Mpiyakhe Dhlamini, a researcher and data scientist at the Free Market Foundation, lamented the fact that individuals will no longer be spoilt for choice. He said the good thing about the private sector is that if someone does something wrong, then customers can leave; you cannot do that with a single payer system.

Anban Pillay, a deputy director general at the national health department, said he expected criticism and welcomed it. “These are things we can fix. In terms of governance and corruption, it needs innovative approaches in order to deal with it. So from our side we will be welcoming of those inputs.”