Described as unworkable and unaffordable, government is hell bent on proceeding with the National Health Insurance (NHI) Bill without addressing concerns and recommendations raised by many participants during the Parliamentary hearing.
Approved by the National Assembly in June, the National Health Insurance (NHI) Bill has once again been dominating headlines with most speaking out against it in its current format and the overwhelming sentiment being that it’s simply being rushed ahead of elections.
For something that’s been on the cards for almost a decade now (the White Paper was published for comment in Dec 2015) you’d be forgiven for thinking the government would have provided more answers to critical questions by now.
The single biggest question that remains to be answered is how the government plans to fund NHI? “Many stakeholders and experts have raised concerns that the National Health Insurance (NHI) scheme envisaged in the Bill is simply unaffordable, particularly as it would require an extensive administrative apparatus,” Martin Versfeld, Prelisha Singh, Glenn Penfold, and Robert Appelbaum, partners at Webber Wentzel wrote in a release.
“A related concern is the extent to which the NHI will rely on the public health care system to deliver services, and the capacity of that system to provide an acceptable quality of services. Given the dire state of public health care in our country, it is surprising that the Government persists with plans to spend vast resources on implementing the NHI. Those resources would greatly improve the delivery of quality health care – and universal access to that care – if they were deployed directly in the public health sector.”
While there’s no question that SA’s healthcare professionals and their governing institutions all support universal health coverage (UHC) they spoke almost unanimously after parliament passed the NHI Bill last month expressing concern and disappointment at government’s actions. “We cannot endorse the NHI in its current form, as the chosen vehicle by our government,” the South African Medical Association (SAMA) said in a media statement. “SAMA calls for clear and transparent governance structures within the NHI framework, promoting inclusivity and meaningful representation from healthcare professionals and other stakeholders.”
SAMA further recognised the importance of sustainable and equitable financing mechanisms for NHI and advocated for a thorough assessment of funding options, ensuring that the burden does not disproportionately affect any sector or group. “The Department of Health needs to demonstrate that it can be entrusted with managing this system's public and private finances. Unfortunately, the trust deficit from the previous misappropriation of funds leaves much to be desired.”
Both the South African Private Practitioners Forum (SAPPF) and the Hospital Association of South Africa (HASA) largely echoed SAMA’s sentiments with HASA saying: “We believe that approving the Bill without substantive consideration of the many valid and significant recommendations and contributions made by many participants during the Parliamentary hearing is deeply regrettable and a missed opportunity by the Committee. “To summarily ignore the many who voiced their concerns regarding governance structures and operational efficiency concerns, the concentration of risk in a single-payer system in an unstable economy featuring endemic corruption, and the many other concerns raised by its own attorneys, is short-sighted and highly unwise.”
Worryingly, the healthcare reform decisions taken now will impact the sustainability of SA’s health system and will be deeply felt for generations to come.