A coalition of healthcare professionals has put an alternative to National Health Insurance (NHI) to President Cyril Ramaphosa, suggesting medical schemes be retained along with reforms to make cover affordable to more people and reduce the burden on the public health system.
“The NHI is fiscally and institutionally unimplementable. In particular, there is no feasible scenario in which a single tax-financed fund can provide all the coverage for the entire population,” said the Universal Healthcare Access Coalition, which represents the majority of SA’s healthcare professional associations.
NHI is the ANC’s controversial plan for universal healthcare coverage, which aims to establish a government-controlled fund that will purchase services for all eligible patients and drastically reduce the role of medical schemes.
Despite intense lobbying from organised business and healthcare professionals, Ramaphosa signed the National Health Insurance Act into law shortly before the general election, setting the stage for extensive and protracted litigation.
There are already three separate legal challenges in play — from trade union Solidarity, the Board of Healthcare Funders representing medical schemes, and the SA Private Practitioners’ Forum representing doctors — and several other organisations are weighing their options.
The coalition submitted its plan to Ramaphosa two weeks ago in response to his invitation for workable proposals on NHI, said Aslam Dasoo, convener of the Progressive Health Forum, a member of the coalition. Other influential members include SA’s biggest doctor organisation, the SA Medical Association and the SA Private Practitioners’ Forum. Business Unity SA (Busa), an umbrella body for organised business, has already made submissions to the president on NHI, but has not released the details.
“There has been no health policy reform for the past 20 years. NHI is to all intents and purposes stalled. This is a strategy that will take three to five years to implement,” Dasoo said.
The Universal Healthcare Access Coalition’s healthcare reform framework proposes a three-pronged approach: increasing the number of people who belong to medical schemes, strengthening the public health system, and separating the pooling of funds from the purchasing of health services.
It advocates mandatory medical scheme membership for people on higher incomes, accompanied by mechanisms to pool risk between schemes. These include a risk equalisation scheme to stop schemes competing for young and healthy lives and social reinsurance to protect smaller schemes from the destabilising effects of high-cost, rare events.
The existing tax credits for medical scheme members are to be replaced with an income-related contribution subsidy, and a new “publicly sponsored” medical scheme is to be launched to compete with private schemes.
In line with the recommendations of the Competition Commission’s health market inquiry, it proposes standardising benefit packages and implementing a structure for multilateral tariff negotiations.
The reforms proposed by the coalition are fiscally sustainable because expanding medical scheme access will reduce the burden on the public healthcare system, and increase the resources available to low-income households, Dasoo said.
The government had “failed miserably” to ensure everyone had access to the healthcare care they needed, and the inequities in SA’s health system had worsened under health minister Aaron Motsoaledi’s watch, he said.
Motsoaledi served as health minister from 2009 to 2019, and was then appointed to the home affairs portfolio. He returned to the health portfolio in the government of national unity, formed after this year’s general election.
The Universal Healthcare Access Coalition said the provision of free public services could be enhanced by strengthening governance measures such as removing political interference from appointments, procurement and operational decisions. Hospitals and district authorities should be given greater autonomy, and overseen by independent supervisory boards.
It it also called on the government to initiate a discussion with neighbouring states to establish a financing mechanism to cover the costs of their citizens’ use of SA’s public health services.
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