The health department has defended its failure to implement the recommendations of the competition commission’s Health Market Inquiry (HMI), saying many of the issues identified in the organisation’s final report will be dealt with when National Health Insurance (NHI) is in place.
The inquiry spent five years investigating the private healthcare market and published its final report in September 2019, making far-reaching recommendations aimed at improving competition and giving patients a better deal. It said at the time that a better-regulated private sector was vital if the government was to purchase services from private healthcare providers under NHI.
NHI is the government’s policy for universal health coverage, which aims to ensure everyone has access to services that are free at the point of delivery. Its first piece of enabling legislation, the NHI Bill, was passed by the National Assembly on Tuesday and has been sent to the National Council of Provinces for concurrence.
Health officials had considered how the HMI’s recommendations fit with the government’s plans for NHI and concluded some were unfeasible, said Nicholas Crisp, the department’s deputy director-general for NHI.
“For instance, they recommend implementing a Schedule 3A public entity supply-side regulator. Well, that’s exactly the role of NHI, to be the supply-side regulator for the whole system,” Crisp said. “It would be superfluous to have another Schedule 3A public entity just to regulate the private sector while we are waiting to create the NHI.”
Creating a Schedule 3A public entity was not straightforward, as it required an act of parliament, he added.
The supply-side regulator was central to the inquiry’s recommendations and was intended to oversee multilateral tariff negotiations between healthcare practitioners and medical schemes. It was also to take on the responsibilities of advising on best practice, issuing facility licences and practice numbers, and liaising with a new body to monitor the quality of care, known as the Outcomes Monitoring and Reporting Organisation.
These were all elements that formed part of NHI, said Crisp. “Why would we do a separate outcomes measurement for the private sector when it is part of what we are doing in the NHI,” he said at a press conference this week.
There were aspects of the inquiry’s report that meshed with NHI, he said, such as its recommendation that all medical schemes offer a single, standardised benefit package instead of the myriad options now on offer.
“We would like to see the revision of prescribed minimum benefits harmonised with the (NHI’s) primary healthcare package and become that single compulsory product because that is exactly where the NHI is going,” Crisp said. Prescribed minimum benefits refer to the minimum basket of care that all medical schemes must cover, regardless of which benefit option a member belongs to.
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