Regulating doctors' fees could further harm healthcare
This is one of the concerns that has come to light since Health Minister Aaron Motsoaledi released the National Health Insurance (NHI) and Medical Schemes Amendments bills last week for comment.
Interested parties now have three months to make submissions and comments on the bills.
As the government released the two new bills to enable the establishment of the NHI, factors likely to determine the success and failure of it cannot be ignored.
Premium healthcare for every South African will be a dream come true - as healthcare is a basic human right.
But factors such as funding, collaboration between the public and private sectors and the availability of a skilled workforce and management arise.
This includes whether this new collaboration can avoid corruption and what will it take to ensure corruption does not rob people of proper healthcare.
The Rapport newspaper on Sunday reported that doctors were ready to oppose the fixed tariff provisions in the bill in court. Rapport said about 3000 doctors who are members of the SA Private Practitioners’ Forum will simply refuse to take part in the project. Its CEO, Dr Chris Archer, told Rapport the forum would go to court to oppose any attempt to introduce across-the-board tariffs.
Henru Krüger, operations manager and legal expert at the Alliance of SA Independent Practitioners’ Associations (Asaipa), also told Rapport that doctors and other medical practitioners would turn to the courts should they be forced to work at fixed rates.
The NHI aims to provide healthcare services to all South Africans, regardless of their income level.
About 16% of South Africans are covered by private healthcare schemes, while the rest rely on the public health system.
According to the Budget delivered in February, the Treasury allocated R4.2 billion to the NHI until March 2021.
Motsoaledi said he had his eye on the R60bn in reserves the medical aid industry had stored away.
There is no doubt the biggest likely winners from the NHI will be the underprivileged. The Board of Healthcare Funders of Southern Africa said it welcomed progress made towards universal healthcare for all. The board represents 45 medical aid schemes, administrators and managed care organisations.
Motsoaledi said the NHI will abolish co-payments, a proposal contained in the amendment bill. This is when a medical aid doesn’t cover 100% of costs and the scheme member has to cover the shortfall.
The amendment means that every cent charged to the patient must be settled fully by the scheme and the patient should not be burdened with having to pay.
But with that will come an uproar from those in the upper tiers who choose private healthcare.
Some may argue that they are already paying exorbitant amounts of tax. But there are examples in developing countries where “relying on referral pathways and leaning on digital solutions have been successful” which South Africa can adjust to, if not, mirror.
The NHI is an ambitious and universal healthcare insurance fund that proposes free top-notch health services to every South African - rich or poor.
The understanding is that once the bill becomes law South Africans would be required to pay towards the fund before they pay for their medical aid premiums if they opt to keep their medical aids.
Addressing the media this week, Motsoaledi said the NHI will pool funds that are contributed by all South Africans into the fund, depending on how much one earns, and will provide everyone with free access to public and private sector providers across the country.
The NHI has been a talking point since 2007 when the ANC adopted the idea at its Polokwane Conference.
Motsoaledi also indicated that government subsidies for public servants and the schemes that are restricted to government employees would eventually be scrapped, as there would be no need for them.
However, those who can afford to pay for medical aids will have an option to top up.
According to the NHI Green Paper, NHI will be implemented in three phases over a 14-year period but the bill does not give an actual date of implementation. The 5-year pilot phase on NHI was phased in in April 2012. The pilots were meant to serve about 10270000 people or 20% of the country’s population.
National Treasury has allocated R1billion for the pilots across 10 districts in the country.