NHI model will harm the entire SA healthcare system

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Although the concept of Universal Health Coverage and access to quality healthcare for all South Africans are supported, the South African Private Practitioners’ Forum (SAPPF) says they do not support the National Health Insurance (NHI) model chosen.

The forum strongly believes that the proposed NHI model will cause irreparable harm to the entire South African Healthcare industry if implemented and that the NHI will not lead to the progressive realisation of access to healthcare that is demanded by Section 27(2) of the South African Constitution.

By implementing this model in an environment which is not able to afford a very comprehensive NHI service basket, it will lead to the majority of South Africans having less access to comprehensive health services than is currently the case in both the Public and Private Sectors. This would not be the progressive realisation of healthcare that is demanded by our constitution. All indications have suggested that the service basket would be adapted to the available budget, which could lead to an ever-shrinking set of services being made available to users.

In addition, SAPPF is most concerned by attempts to implement NHI without the government providing any clarity on what the initiative might cost and how it will be funded in the current economic climate.

The NHI Bill in its current format is still too vague and ambiguous on many aspects pertaining to the NHI. We therefore urge government to reconsider the proposed NHI model until such time as a costing of the system under NHI has been forthcoming and considered in light of the current economic duress in South Africa. It is also of utmost importance that alternative models of universal health coverage, which reflect the practicalities and South African environment, be considered.

A Socio-Economic Impact Assessment (SEIAS) of the current Bill should not focus on comparison between NHI, the status quo and full privatisation, as no one is proposing the healthcare status quo or full privatisation as alternatives to NHI. Instead, the SEIAS should do an honest assessment of the socio-economic impact of NHI in our fiscally strained environment and compare it to other proposed UHC systems which has been put forth by various stakeholders, including the SAPPF.

Section 33 of the Bill indicates that Medical Schemes will only be allowed to provide complementary cover, for services not reimbursable by the NHI Fund. Services rendered by an uncontracted private provider will not be reimbursable by the NHI fund and would therefore form part of such “Complementary Cover” which Medical Schemes may provide. Section 3(3) of the Bill indicates that the NHI Bill supersedes almost all other legislation. 

This would imply that the Medical Schemes Act and the Registrar of Medical Schemes will not be able to limit the ability of scheme options to pay for such uncontracted services, which are not reimbursable by the NHI Fund. This is seen as a positive step for Private Practitioners to be able make the choice of whether they want to contract with the NHI fund or not and still being able to render services to South African patients, even if not contracting with NHI.

SAPPF remains concerned with the ability of government to successfully implement the Presidential Health compact to radically improve the quality of the public sector. Failure of the Health Compact to turn around every facility in the public healthcare sector, will mean that the public sector facilities will not be of sufficient quality to contract with the NHI Fund. The continued implementation of the NHI, without confirming that the Presidential Health Compact was successful, could do immense damage to the Healthcare system and could result in a shortage of public sector service providers for the NHI Fund to contract with. We find it unlikely that incumbent managers, who have overseen large scale state failure for many years, will implement the Health Compact successfully and turn around the Public Sector.

The Bill remains vague on the compensation of Private Practitioners under NHI, only indicating the Minister may make Regulations pertaining to such reimbursement models. The indication of specialists forming part of DRG reimbursement in Private hospitals, raises the concerns associated with doctor employment in private hospitals. In a 2017 survey amongst SAPPF members, 54.7% of respondents indicated that they would not want to be employed by hospitals. 

These figures should serve as a warning on sentiment of employment amongst doctors and reimbursement models and Regulations that do not require such employment should be forthcoming with utmost speed, prior to any reimbursement models being implemented which propose and force the employment of specialists by hospitals.

SAPPF will be seeking a meeting with the Minister of Health to discuss the concerns and to provide a better understanding of the government’s thinking on some issues in an attempt to find common ground, so as to encourage full participation by the private sector in the much-needed reform of South Africa’s healthcare services.

The South African Private Practitioners Forum (SAPPF) is a voluntary association of private practitioners working in the South African private health sector. The organisation has a membership base of approximately 3000 specialists representing most specialist disciplines, as well as 3500 other practitioners, including General practitioners and ancillary healthcare practitioners.