Despite government’s intention to introduce a single health system with compulsory contributions from all working South Africans, it may be impossible to outlaw private healthcare.
This is according to Wits University’s Professor Alex van den Heever, who has been researching health reform for over 20 years.
“The National Health Insurance (NHI) Bill is obscure about whether people can buy cover outside of the national scheme, and refers to private cover that is complementary,” said Van den Heever.
“But you cannot just remove a right. The NHI is insurance, not a service. Canada tried to prohibit people from having private healthcare and they lost a court challenge. Prohibition serves no public purpose or social benefit.”
Open to capture
Health Minister Aaron Motsoaledi released the NHI Bill along with the Medical Schemes Amendment Bill late last week as government’s first legislative steps to set up one health service for all.
Van den Heever also believes that the NHI Bill centralises too much power in the hands of the health minister and does not clarify how the scheme will be governed.
“The NHI Bill gives too much discretionary power to the health minister for operational issues, and this makes the scheme vulnerable to being captured,” said Van den Heever.
“It is not appropriate to put billions – about R170-billion a year currently – in the hands of one politician,” said Van den Heever, who spent 10 years as an advisor for the Council on Medical Schemes.
According to the Bill, the Health Minister will be responsible for appointing virtually all those who will implement the NHI, including the head of the NHI Fund, the head of the complaints division and the head of the Office of Health Standards Compliance (OHSC), the body that will decide which health facilities will qualify to serve the public.
However, Van den Heever said that there were some good proposals in the amendments to the medical schemes, such as the tightening up of definitions.
But replacing the prescribed minimum benefits that all schemes were obliged to pay with unspecified “comprehensive benefits” was not helpful.
In addition, he said medical schemes’ reserves were designed to protect members and the 25% reserve was only three months’ worth of members’ contributions.
“The Bill does not actually ban brokers, as the Minister claims,” added Van den Heever. “Currently, a medical scheme administrator allocates you to a broker and you have to pay the fee. The amendment says members have to agree to this arrangement and the fee.” – Health-e News.