The NHI Act currently poses more questions than it answers. But responsible reform is the route to achieving a sustainable quality healthcare system.
The National Health Insurance (NHI) Act, signed into law on 15 May 2024, has prompted extensive deliberation due to the myriad questions it raises for the healthcare industry and medical aid schemes. South Africa is currently in the process of articulating a vision for an optimal healthcare system. However, it is important to acknowledge the disparities between this vision and the current state of affairs.
Lay of the land
In line with the objectives of the United Nations Sustainable Development Goal 3 on good health and well-being, we recognise the need to approach health reform responsibly by leveraging our existing infrastructure. It is crucial to acknowledge the valuable elements within the country’s healthcare ecosystem, which should be retained even amid aspirations for a utopia.
Implementation of universal healthcare needs to be undertaken in a collaborative way to be sustainable. We believe there continues to be significant potential for private sector participation in the final solution. Only through constructive engagement can we develop a solution that helps all South Africans in the health value chain.
The healthcare industry – through its various representative associations and private healthcare service providers – has actively provided substantial engagement, including the parliamentary processes with submissions and on the platforms provided by government. As an organisation, PPS – in association with our graduate professional members in the healthcare industry – contributed comments to the NHI Bill and offered suggestions on how to make the Bill more practical to meet the aims of serving all South Africans.
However, consideration by the industry of these inputs, among others, appears not to have been addressed in the NHI Act, resulting in many questions remaining without clarity.
Understanding the NHI Fund
Of primary importance and the appropriate next step is the implementation of the NHI Fund, which requires a multi-player approach and a reorganisation of the health system. With the NHI being the single purchaser and funder of health services in the country, it is critical to understand the services that will be procured by the Fund.
Currently, there is no clarity as to what will fall within the Fund basket and what will be specifically excluded. This could have a material impact on how healthcare professionals, who are among our members, are able to work within the healthcare ecosystem.
In addition, the Money Bill needs to outline how the NHI will be funded. The powers of the Minister of Health along with those running the NHI Fund need to be defined to ensure transparency in procurement and spending practices. Strong capabilities in HR management as well as the administration of patient management systems, cost, waste and efficiency management through proven technology infrastructure are vital. In addition, the accreditation of institutions to be able to provide services to the Fund, requires consideration.
Consultation during the next phase of the NHI Fund is imperative from a constitutional perspective, addressing implications of both the right to access healthcare and freedom of association. This is an important consideration when reviewing Clause 33 of the NHI Bill, which is perceived as challenging a basic right of South Africans when it comes to choosing the kind of healthcare coverage they wish to get.
Phasing it in
Without the participation of the private sector, the loss of skills to support the NHI will also be amplified.
Therefore, a phased approach that fixes the healthcare system in terms of infrastructure, funding, the supply of services, human resources and administrative and technological reinforcements is required. Recommendations highlighted in The Health Market Inquiry (HMI) should be considered and implemented for the private sector to also improve the challenges and concerns. In this way we can build a solid foundation, ensuring a sustainable health system that delivers quality healthcare services to South Africans.
While the date that the NHI will come into effect is not yet known – based on outstanding processes and other supporting legislation – it is not expected to be completed in the short- to medium-term. Industry and government should continue the consultative process to identify opportunities for a more universally accepted workable solution.
Until such time as the NHI Fund can provide full comprehensive coverage for all South Africans, medical schemes and providers of health insurance products will continue to provide their services.
Health professionals and South African citizens also have a right and opportunity to comment on proposed legislation through public hearings.
NHI needs genuine engagement drawing on global experience within a South African context and allowing the private and public sectors to jointly give it a chance to succeed. As an organisation, we stay committed to standing for the interests of graduate professionals who are important contributors to the South African economy through the taxes they contribute as well as service delivery in the health sector.
