National Health Insurance (NHI) has the potential to make or break SA healthcare, depending on the strength of its foundation. With the extensive world-class skills and experience in medical funding on offer within SA’s private sector, the NHI will require working together to develop universal health coverage that will best serve society, writes Phumelele Makatini, chief executive officer of the Health Funders Association (HFA).
Fundamentally, we all want the same thing – a functional, quality healthcare system that is within reach for all, a health cover industry body representing over 50% of lives covered by medical schemes.
FULFILLING AN ESSENTIAL NON-PROFIT SOLIDARITY MANDATE
During 2021, medical schemes collected R225 billion in membership contributions and paid out more than 91% of this for members’ medical treatment. This efficiency in private healthcare funding is fulfilling a non-profit social solidarity mandate to care for members' health on a large scale.
This closely mirrors the aims envisaged by NHI, and the medical scheme industry can bring this experience and capacity to a collaborative effort to build the NHI we all want for our children. The cover currently provided by medical schemes has much in common with this social security framework as prescribed minimum benefits ensure members never run out of cover for in-hospital care, chronic conditions, or life-threatening emergencies.
EXPANDING ACCESS TO QUALITY HEALTHCARE
Medical schemes contract with designated service providers to protect members from out-of-pocket payments, and the treatment pathways are also broadly similar to what is being proposed under NHI. Considerable inroads have been made in establishing quality healthcare access, which will be further enabled with the long-awaited finalisation of a low-cost benefit option framework.
It has been indicated that the NHI will be implemented gradually in a phased approach. As we all know, healthcare access is not something a person can necessarily afford to wait years for. Even when the NHI is functional, it may be decades before it is equipped to offer the comprehensive quality care we would all want for our families.
In the meantime, medical scheme members are relieving pressure on public health facilities through providing unlimited cover for chronic conditions and some 300 common health conditions in the private sector.”
Health funders will continue to broaden and fine-tune healthcare access mechanisms for the benefit of more South Africans as far as possible within the regulatory parameters, thereby further easing the burden on the public health system. We are rolling up our sleeves and are ready to assist in improving healthcare for all.
Until the NHI is fully implemented, there is a joint responsibility to do everything possible to preserve the pockets of excellence in the public sector and find workable solutions to raise the level of healthcare generally to the standards of care that private healthcare funding has made possible.