Sir – Although the concept of universal health coverage (UHC) and access to quality healthcare for all South Africans is supported, the South African Private Practitioners’ Forum (SAPPF) says it does not support the National Health Insurance (NHI) model chosen.
The forum strongly believes the proposed NHI model will cause irreparable harm to the entire South African healthcare industry if implemented, and NHI will not lead to the progressive realisation of access to healthcare 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 demanded by our Constitution. All indications have suggested 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 NHI. We therefore urge Government to reconsider the proposed NHI model, until such time the 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 have been put forth by various stakeholders, including the SAPPF. 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 the NHI Bill supersedes almost all other legislation. This would imply 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 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.
Dr Chris Archer – SAPPF CEO
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