Absurd. That's the experts' verdict on NHI
Can medical aids truly exist alongside National Health Insurance? The minister thinks so. Experts disagree
Health Minister Aaron Motsoaledi has promised that medical aids will continue to exist alongside National Health Insurance (NHI) – but the very bills he has proposed seem to say the opposite.
In fact, according to experts, the bills – in their current forms – say that medical aids can only cover what NHI doesn’t. In effect, this means that if the NHI fund covered a caesarean section, medical aids wouldn’t be allowed to pay for the procedure, a move that would drastically change how the middle class access healthcare.It is a contradiction that, experts told Times Select, could very well see the Health Department facing lawsuits.
Section 17 of the proposed Medical Schemes Amendment Bill – which was announced alongside the NHI bill – says that the “registrar may, after consultation with the minister, restrict the extent of benefits offered by medical schemes, having regards to the benefit and services coverage under the [NHI] Fund thereby eliminating duplicative costs for the same benefit”.
In simple terms, the amendment means that the registrar, who is the head of the regulator of medical aids, and the Health minister can limit coverage medical aids are allowed to offer. It is a change that would affect the more than eight million people (17% of the population) who are on medical aid cover.A senior economist at Econex consultancy, Dr Paula Armstrong, said: “The way I understand the Medical Schemes Amendment Bill is that if the NHI fund pays for the health services, then medical schemes cannot legally cover the same services. Medical schemes would be for top-up cover and complementary procedures.”
Experts, however, warn that the restriction on medical aid cover could be overthrown in court.
A professor at the Wits School of Governance, Alex van den Heever, said both the NHI and Medical Schemes Amendment bills tried to restrict what medical aids could offer, reducing the access of middle class to health.“If the government wants to take away a right to healthcare they need to do so with a rational purpose. Rationality is a constitutional principle. Restricting access to private healthcare has no rational reason,” he said.
Van den Heever added that this attempt to “prohibit medical schemes from covering benefits covered by the NHI Fund” was absurd.
“This is an absurd infringement of the right to healthcare as it would force everyone to use a public health system which cannot be held to account for performance. I do not see this provision ever seeing the light of day as no health system in the world takes away the right of people to select their own care with their own money,” he said, repeating that there was “no rational public purpose” served by the provision.He pointed out that the only country that has tried to limit private health insurance was Canada – and it didn’t go well.
Van den Heever said: “This didn’t pass because the Canadian Supreme Court ruled the state couldn’t prove people were harmed by being allowed to buy private health insurance.”
He then called on government to explain the rationale behind the amendment.
“There is no analysis and reason for the new laws they propose. They need to explain their objectives,” said Van den Heever, who has helped draft medical aid legislation in the past.
If medical aids couldn’t cover a procedure, the patient would either have to get it done through health services that National Health Insurance fund paid for – which could be state or private.
“The waiting list for treatment would just be much longer,” said healthcare analyst Dr Nicholas Burger, of Frost and Sullivan.
Van den Heever wrote the Medical Schemes Amendment Bill in 2008. When it wasn’t passed, he worked on 2010 bill, parts of which are mimicked by what was released last week.He said that a number of clauses were added that were unnecessary and contradictory – additions that received a scathing assessment.
“They don’t know what they are doing,” he said. “They have not thought it through. I don’t see them reasonably implementing the proposed Medical Schemes Amendment Bill in the foreseeable future.”His analysis of the bill in its entirety? “I get an overriding sense of general ignorance. The NHI won’t happen.”
Medical lawyer Neil Kirby said there would be multiple ways to challenge the restriction on medical schemes.
“If one argues that the limitation on benefits that must be available from medical schemes constitutes an unreasonable limitation on a medical scheme’s right to trade, alternatively, an unreasonable limitation on a medical scheme’s property rights, then the limitation would be unlawful by virtue of the Bill of Rights. However, that argument would have to be unpacked, in due course, in the legislative process to which the Bills are subject,” said Kirby.
Motsoaledi has stated that committees would decide on what the NHI benefits would be. But this in itself has been problematic. Nine months after adverts were placed calling for members to stand on NHI committees, they have not yet been formed.
With no committees, there is no clarity on what NHI would cover, said Burger.
“There is still going to be a committee to discuss and decide what NHI benefits will be covered,” said Armstrong.