Developing the legal framework to breathe life into the National Health Insurance (NHI) policy is likely to take twice as long as the government has planned, one of SA’s leading healthcare lawyers told delegates at the annual Hospital Association of SA (Hasa) conference on Wednesday.
It will require such a complex set of legislative reforms, it will be impossible to achieve by 2022, said Werksmans Attorneys’ director of healthcare and life science practice, Neil Kirby.
The NHI aims to provide quality healthcare services to everyone, which is free at the point of delivery, and to narrow the gap between the care currently available to the rich and poor. The government’s latest policy on NHI is set out in a White Paper released by Health Minister Aaron Motsoaledi in June, which says the enabling legislative framework for NHI is to be developed between 2017 and 2022.
In addition to amending 11 existing healthcare acts, the government would probably need to craft two entirely new pieces of NHI-related legislation, said Kirby. This would likely involve an NHI Act stipulating who would belong to the scheme and the role of providers, and an NHI Fund Act to deal with the financing mechanisms, he said.
Amendments would probably be needed to the Consumer Protection Act and the Labour Relations Act as well. Once the acts had been promulgated, they would require enabling regulations to bring them into effect, Kirby said.
"This is gargantuan, paradigm-shifting stuff. [This] is an incredible burden on Parliament, which has to deal with numerous issues: this is not an issue that necessarily takes precedence over other legislative processes," he warned. "This cannot be rushed, but the slower it is, the more jittery everyone becomes."
Hasa is an industry body for private hospitals, and its annual conference gathers some of the most influential players in the private healthcare sector. This year, NHI was the key talking point, as the White Paper has created a climate of uncertainty for private healthcare providers and funders.
Econex director Mariné Erasmus said patients would get a better deal far sooner if healthcare experts turned their attention to fixing the public sector’s management issues instead of debating the funding reforms required for NHI. She sketched a picture of the massive health burden facing SA, arguing that the country’s poor outcomes were due to bad governance rather than a shortage of money. SA spent a greater proportion of GDP on public healthcare than Thailand did, yet Thailand had better health outcomes, she said.
"We may require additional funding, but for now it is a great distraction. We should be focusing on delivering better services — the real solution we need is likely to be less costly and produce better outcomes." The scale of the problem confronting the public healthcare sector was highlighted by the Office of Health Standards Compliance, which found two thirds of public hospitals and clinics did not meet the grade, she said, citing its 2014-15 annual report.
SA has one of the world’s greatest misalignments between development and health progress, according to The Lancet’s latest Global Burden of Disease study, Erasmus said. According to the study, while life expectancy has improved in the past decade, SA is one of only a handful of countries in which the number of healthy years a person can expect has declined, as disease and injury take their toll: a South African man born in 2016 will enjoy only about 51.5 years of good health, down from 52 in 1990; while a woman born in 2016 can expect to have 56.1 healthy years, down from 58.6 in 1990.
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