NHI: 'It will not be like Eskom and SAA'
Aaron Motsoaledi presents the long-awaited NHI bill but leaves more questions than answers
Health Minister Aaron Motsoaledi had a lot of news to share on Thursday when he presented both the National Health Insurance and the Medical Schemes Amendment bills. But one of the pressing questions – exactly how NHI will be paid for – largely went unanswered.
Instead, the minister said it was up to Treasury to determine funding. And he stuck to the adage that a spoonful of sugar makes the medicine go down, it seems – he promised the country would not do something unaffordable.Replying to concerns on how medical aids would survive if the suggestion in the the Medical Schemes Amendment Bill that co-payments be scrapped is adopted, he said he was “quite sure they will manage”.
The green paper on NHI was submitted in 2011, and detailed a proposed law for how affordable high-quality health care for all will be introduced.
In many submissions on NHI from SA Private Practitioners to the Helen Suzman Foundation and hospital groups, analysts asked about paying for the scheme. Two papers done by different economists suggested a R200-billion shortfall by 2025.Motsoaledi did reveal there would be a single fund to pay for all health services in the country, both state and private. Contribution to the fund would be mandatory and it would purchase all health services for both private and state patients.
It appears medical aid schemes will be paid for on top of NHI.
When asked if people would be paying tax for health care, an NHI fund and then for a medical aid, he would not explain and said, “Treasury had to decide”.
The minister was adamant medical aids would continue to exist. The only ones that could be affected would be medical aids belonging to government, such as the Government Employees Medical Aid scheme and Polmed. These could be merged into the NHI fund.
The NHI fund will be managed by a board, he said, and he would not rule out using private expertise to help administer it.
The primary aims of NHI would be to move state money from provinces, which at present provide health care and receive over 90% of the health budget.
Motsoaledi said he got only two percent of the annual national budget, yet had to answer as to why the provincial hospitals weren’t functioning.
He said NHI would be modelled on the private sector where consumers can refuse to spend money on bad doctors and hospitals. He said this would improve quality as money wouldn’t be paid to dysfunctional hospitals.Questioned on the viability of a state-run fund paying every hospital and doctor in country he said: “It will not be like Eskom and SAA.
“A judge has been appointed to investigate state capture. We are not going to repeat the same then from NHI. We are going to copy the British National Health Service.”
He wants to stop corruption by having a central procurement office to buy all medical supplies for hospitals, from medicine to large equipment.
Asked how a single fund would improve state healthcare and fix dysfunctional hospitals, he said “specialists and staff followed resources”.
He also did not give details on what services private and public hospitals would have to provide respectively under NHI, saying it was yet to be decided by NHI committees.
He criticised private health cares’ “aversion” to government interference.
“Private health care assumes not man can put it asunder as if it was given by God.”Discovery Health, the largest medical aid administrator in the country, welcomed the NHI bill, noting it did allow medical aids to exist.
CEO Jonathan Broomberg said. “Based on our initial review of the NHI bill, we are supportive of the general approach taken, including the fact that medical schemes will continue to operate alongside the NHI. We are also supportive of the various governance and advisory mechanisms established.
“The inequalities in access to quality healthcare services for all South Africans is a major concern for all South Africans.”
But Discovery could not yet comment on the great shake-up to medical aids.
“The draft Medical Schemes Amendment Bill contains numerous complex amendments to the Medical Schemes Act. We are still studying the details of the draft bill.”
Medical lawyer Neil Kirby was a little more critical.“The NHI bill proposes the introduction of a national health insurance scheme and fund.
“This is a controversial step in the current context of the healthcare services debate in South Africa, more particularly, in the wake of the Life Esidimeni findings and statements concerning the ability of the public healthcare sector actually to provide access to healthcare services at all in certain settings.”
He said the fund did not address weaknesses in the state sector. “Further examination of the structure reveals a paper-based set of aspirations largely divorced from the realities of public sector infrastructural problems and endemic capacity constraints . It's a bit like building a house with no land on which to put it.”
Both bills will for the next three months be up for public comment.