The government hopes to have rolled out the National Health Insurance (NHI) Bill by 2026. Since it’s official promulgation in August last year, 2019, the Bill continues to spark much debate among South Africans in the public and private sectors. Whether you are for or against the NHI Bill there is no denying the fact that in a society like South Africa where inequality is rife and access to quality healthcare is limited to the privileged few, universal healthcare coverage (UHC) would go a long way in improving South Africa’s healthcare system.
On the 11th of February, Power FM hosted an NHI Dialogue that brought together members of the public and private sector to discuss critical components of the NHI debate. Sponsored by RH Bophelo, the dialogue presented an opportunity for the public, civil society and the private sector to voice their concerns regarding the Bill and the implementation thereof.
The panel included Dr Anban Pillay, deputy director-general for National Health Insurance at the Department of Health; Dr Donald Gumede, chairperson of the National Healthcare Professionals Association; Sibongile Tshabalala, chairperson of the Treatment Action Campaign; Dr Rajesh Patel, the head of benefit and risk at the Board of Healthcare Funders of South Africa; Dr Bandile Radebe, interim president of the African National Congress Professionals League (ANCPL), and Shelly Mcgee, the head of research at the South African Medical Association.
Facilitated by Power FM’s Aldrin Sampear, the dialogue created a platform for rigorous debate and much-needed engagement on the topic of the NHI Bill. To kick off part one of conversation, Dr Anban Pillay shed light on what the NHI is and how South Africans will benefit from it. He described the NHI as a “funding mechanism that allows [the government] to pool funds from the entire citizenry of South Africa into a single Fund and buy healthcare services on behalf of all South Africans.” According to Dr Pillay, the fund will ensure that all South Africans have access to private healthcare. What this essentially means is that South Africans won’t need medical aid to access healthcare in private hospitals. Moreover, he stated that South Africans who don’t have medical aid won’t need to travel long distances to get to a public hospital and stand in long lines to get help. The NHI Fund will make it easier for them to go to the private clinic that is closest to their area of residence.
Chairperson of the Treatment Action Campaign, Sibongile Tshabalala said that the TAC’s concern is the way the bill is drafted. “We don’t have a problem with NHI because we believe in universal health coverage and we believe that poor people need to get quality healthcare services.” When asked about the exact problem the TAC has with the Bill, she cited the fact that the Bill gives too much power to one person, in this case the health minister, which leaves little room for accountability and transparency. The concern for them is around who will be selected to head the fund and be in charge of implementing it, and on what basis NHI leadership appointments will be made. This speaks to concerns of corruption, which many South Africans have voiced. “How will civil society voice concerns if all the power is allocated to one person?” asked Sibongile.
Dr Donald Gumede joined the conversation to share the concerns of most healthcare practitioners, stating that while the NHI is “a great concept that encourages professionals to work together,” there are concerns regarding methods of payment, which he felt were not clearly outlined in the Bill. Dr Pillay spoke to Dr Gumede’s concerns, stating that the Bill has accounted for the remuneration of health practitioners and that “reimbursement to practitioners will cover the cost of running their practice and provide a reasonable income as a salary.” For Dr Gumede, it is important that practitioners be compensated well and that patients get the treatment that they need because “health is not a commodity; it is a right, as it is stipulated in section 27 of the constitution.”
Dr Patel addressed the concern that the NHI will put medical aid schemes out of business. Medical aid schemes currently serve a very small percentage of the population, which increases the inequality in the healthcare system. The NHI is not replacing medical aids; medical aids will provide cover for services not reimbursable by the NHI Fund. As stated by Dr Patel, “the NHI will not afford to cover all healthcare services and procedures.”
In part two of the conversation, Dr Bandile Radebe joined us to provide clarification regarding where the funds for NHI would come from and what they will be allocated to. “There is an assumption that when we are speaking about the total budget that’s required for the NHI, we are starting from scratch. We’re not. From a public sector perspective, there is about R200 billion that has been allocated to comprehensive services, which is part of what the NHI would be…what we will be looking for is an amount that will be added to existing funds.” According to Dr Bandile, the NHI fund will be used to standardise the quality of healthcare across the private and public sector. He noted that private hospitals have more resources than they have patients, what he refers to as a “latent capacity.” NHI will ensure that this latent capacity is utilised to provide coverage to the majority of South Africans who can’t afford private healthcare.
Much of the debate around NHI isn’t around whether or not it is needed. The Power FM NHI dialogue brought up the following questions and concerns: Where will the funds come from and how will they be used? Who will lead the implementation of the Bill and how will the NHI be protected from corruption? How will the Bill affect medical doctors and medical aid schemes? Wherever you find yourself in the debate, it is indubitable that the NHI is needed. Moreover, quality infrastructure is required to ensure that there are enough hospitals to meet the demand for healthcare in South Africa.
RH Bophelo believes the government will need to invest in their infrastructure in order to strengthen the public healthcare, equally so, the private sector can assist the government by investing in more infrastructure that the NHI Fund can utilise for the healthcare delivery for all.
Government must consider other alternative ways for funding the infrastructure gap, other than the fiscus, South Africans are under pressure and will not afford to pay more in taxes. We are all breathing through the wound, and can barely survive month on month.
Universal health coverage is defined as ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship. All UN Member States, which South Africa is a member of, have agreed to achieve universal health coverage(UHC) by 2030, as part of the Sustainable Development Goals.
For any successful implementation of UHC, it will require efforts from both public and private sector to rally in support of the centralised NHI Fund for healthcare services.