The government’s plan for universal health coverage as it is set out in the National Health Insurance (NHI) Bill will leave people worse off and deter globally mobile professionals from working in SA, Business Leadership SA (BLSA) CEO Busi Mavuso warned on Monday
The NHI Bill was approved by parliament’s portfolio committee on health last month and is expected to be passed by the National Assembly within the next few weeks. The bill will then be considered by the National Council of Provinces, a process likely to take at least a year.
It paves the way for the establishment of a single NHI fund that will purchase services from public and private sector providers on behalf of citizens, and pares back the role of medical schemes to the point where they will be allowed to offer cover for services not provided by NHI.
It has been roundly criticised by the private sector, including SA’s biggest doctor organisations, private hospitals, and SA’s biggest medical scheme administrator, Discovery Health.
Writing in her weekly newsletter, Mavuso said the bill would throttle the private healthcare sector.
“By forcing the private sector out of the provision of all but a limited set of complementary services, private provision would effectively cease. For globally mobile businesspeople and their families, this would be another serious disincentive to work in SA.”
“To be clear, business would benefit from an environment in which everyone had good quality healthcare. One in which no-one had it would be catastrophic,” she said.
“This direction of travel reflects nothing of the learnings from other critical interventions that government and business have achieved by working together. The electricity crisis is an obvious example, where the introduction of large-scale private electricity generation has led to a dramatic increase in the number of projects now being built to add capacity to the grid,” she said.
The private sector could complement government efforts, speed up investments, and reduce costs, she said, citing the coronavirus pandemic as an example.
The business sector worked closely with the government to source equipment and medicines, and to rapidly expand the provision of Covid-19 vaccines at sites across the country. “It was a clear demonstration that national health outcomes are achieved faster and more efficiently when government and business work together, drawing on their respective strengths,” said Mavuso.
Many other countries had implemented effective universal health coverage systems based on a multi-funder model, she said, urging the government to reconsider the role of medical schemes under NHI. Brazil and Thailand were among the developing countries that provided health services with a blend of private and public cover, she said.
Last week the Hospital Association of SA (Hasa), which represents SA’s biggest private hospital players, urged the National Council of Provinces (NCOP) to heed the concerns expressed by stakeholders during the public hearings held by the portfolio committee on health.
It called on the NCOP to insist on a multi-payer model to mitigate against the concentration of risk posed by the bill’s single-payer system, ensure there was an iterative rollout based on milestones rather than dates, and step up the bill’s governance provisions to ensure the NHI fund was not left open to theft and corruption.
Update: June 7 2023
This story clarifies that the bill still requires consideration in the National Council of Provinces
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