SA’s biggest medical scheme association has urged legislators to rein in the power given to the health minister in the National Health Insurance (NHI) over the future role of medical schemes.
The NHI Bill is the first piece of enabling legislation for the ANC government’s plans for achieving universal health coverage, and is being considered by the National Council of Provinces (NCOP). Section 33 of the bill says that once the minister has determined that NHI has been fully implemented, medical schemes “may only offer complementary cover” for services that are not provided under NHI.
These provisions offered no guidance on how the minister would determine when NHI was fully implemented, vesting too much power in the hands of one person and creating uncertainty for medical schemes and their members, said the Board of Healthcare Funders (BHF).
The bill provides for the establishment of a central NHI Fund that will purchase health services for SA citizens from accredited public and private providers, which will be free at the point of delivery. It was passed by the National Assembly in May, and is now before the NCOP, SA’s second house of parliament. The NCOP has called for public submissions on the bill, and recently extended the deadline for written comment until September 15.
The BHF had made a submission to the NCOP urging MPs to revise section 33 of the bill to include a set of criteria that would have to be met before the minister could declare the NHI fully implemented, said BHF head of health system strengthening Rajesh Patel.
These include ensuring that at least 75% of the population has registered with the NHI Fund, an assurance from the minister of finance that the fund can pay for health services for at least five years, and that at least 80% of SA’s health facilities have been accredited.
As it stands, section 33 allows the minister to “spring the news on medical schemes with no advance warning that they may only provide complementary cover”, the BHF said in its submission. “Section 33 is thus contrary to the constitutional principle of administrative justice and allows the minister to act arbitrarily,” it said.
Patel spoke to Business Day shortly after a briefing hosted by the BHF, in which chair Neo Khauoe said the bill failed to address the needs of its members and of SA as a whole. “We need to be sure citizens can access essential health services without experiencing financial hardship. We don’t understand in this model how this fundamental [principle] will be enhanced,” she said.
The government should fix the problems facing SA’s “decayed” health system, rather than imposing a new financing mechanism on top of it, she said.
Wits governance expert Alex van den Heever said SA already had a universal health coverage system that protected citizens from financial hardship, and the government should focus on fixing its flaws instead of trying to impose NHI. People who could afford membership belonged to medical schemes that provided cover for future healthcare expenses, while those who could not afford medical scheme membership relied on taxpayer-funded public health services. The result was a system that largely protected people from catastrophic medical expenses, he said.
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