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SPECIAL REPORT: MEDICAL COVER OPTIONS
Thursday July 21 2022 Sowetan
NHI — can SA really afford it? Lack of clarity still plagues the proposed bill Reports by Lynette Dicey
Most stakeholders agree that the current healthcare system, where the majority of the population rely on the public sector for the provision of health care, is not sustainable. The draft National Health Insurance Bill, published in 2019, proposes a system of universal health care for all South Africans based on pooled funds to provide access to quality and affordable health care to all the country’s citizens, irrespective of their socioeconomic status. However, of concern is the many unanswered questions that remain, particularly about whether the country can afford to fund National Health Insurance (NHI). Other concerns, particularly given the recent Covid-19 funds fiasco, is why this time will be different:
Lee Callakoppen, principal officer at Bonitas Medical Fund, says the proposed bill is fraught with illegalities. /SUPPLIED
can the funds avoid being subjected to fraud and corruption, and does the government have the ability to manage such an enormous undertaking given its poor track record of managing state-owned entities. Civil society organisations are among those who have expressed concerns over the government’s lack of clarity. What is unclear is exactly what NHI would cost SA. The government has previously suggested a figure of R256bn a year, but has provided no explanation for how it arrived at this figure. Other estimations are that it will cost about R700bn a year to administer. Where will this money come from? The 700,000-odd individual taxpayers who already pay about two-thirds of all personal income tax and a hefty chunk of VAT already have a heavy tax burden. There has also been little clarity on what exactly the NHI will offer. The bill defines “comprehensive healthcare services” as healthcare services
that are managed to ensure a continuum of health promotion, disease prevention, diagnosis, treatment and management, rehabilitation and palliative care services across the different levels and sites of care within the health system in accordance with the needs of users. Medical schemes will provide what it calls “complementary cover”, defined as thirdparty payment for personal healthcare service benefits, not reimbursed by the fund, including any top-up cover offered by medical schemes or any other private health insurance fund. Another issue is the contra-
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It’s unclear exactly what NHI would cost SA
dictory nature of the proposed bill. In its current format, it is illegal for medical schemes or health insurance firms to exist — though this contradicts other sections of the bill. Lee Callakoppen, principal officer at Bonitas Medical Fund, says the proposed bill is fraught with illegalities and is in direct conflict with the Medical Schemes Act and existing regulations. “The right of access to health care is much wider than the right to obtain health care through the public sector and includes the right to purchase health care from the private sector, if one can afford it. “The purchasing power of the consumer is a legitimate means of access to health care and consumers must have the right to apply their purchasing power as they deem fit. “However, the bill, in its current form, makes it unlawful for people to purchase healthcare services not covered by NHI.” Alan Fritz, acting principal officer of Medshield Medical
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