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SUB CATEGORIES General  |  HIV |  Medical Schemes | 

In the grand scheme of things

30 June 2021 Myra Knoesen

While the debate continues around the future co-existence of private healthcare and National Health Insurance (NHI) in South Africa, it remains a fact that without change, adaptability and innovative service delivery the important role that private healthcare currently plays will diminish, said Dr Reinder Nauta, Executive Chairman of the National HealthCare Group.

“Legislative limitations imposed on medical schemes have resulted in a situation whereby restrictive and overly cumbersome, costly administrative processes are prohibiting growth in the lower and more underserved segments of the market. This is unfortunately the area where growth is most needed. This has a dual, negative effect on both the healthcare consumer and the industry, which is heavily reliant on new lives in order to remain sustainable,” added Nauta. 

“Modular products, such as Gap Cover, which have become both useful and necessary, are regrettably a sign of the times indicating that medical schemes are no longer able to fulfil their traditional role. Depending on the evolution of medical schemes, a more meaningful role could be developed for brokers to ensure enhanced value-add for both consumers and corporate clients,” emphasised Nauta. 

Sustainability as NHI unfolds

“Health system strengthening is a complex task and must take into account multiple complex factors including disease burden, resource constraints and socio-economic determinants of health, all of which require effective co-ordination and collaboration in tackling these challenges. Given this context, we participated in the Portfolio Committee deliberations on the NHI Bill in the last quarter of 2020. The Bill created room for differing interpretations and for debate on the potential impact on the future role of private healthcare and medical schemes. We will play a constructive role in this important debate, aimed at achieving a sustainable future for private healthcare and for medical schemes, and improved overall access to healthcare for the country,” said Dr Ryan Noach, CEO at Discovery Health. 

“Our strong view is that substantially limiting the role of medical schemes would be counterproductive to the NHI, because there are simply insufficient resources to meet the needs of all South Africans - this is an unavoidable reality. Preventing economically active and productive South Africans from purchasing the medical scheme coverage they need, from their self-generated earnings, will materially curtail their rights, and could adversely impact the sustainability of private healthcare, as well as skills, the economy and sentiment. An approach that integrates and co-ordinates public and private delivery of care is more sustainable and will ultimately be to the greater benefit of all,” continued Noach. 

Nauta commented that, “While the burden of improved accessibility within the private healthcare context rests firmly on the shoulders of employers, the stumbling block that prohibits healthcare access for employed individuals is affordability – even more so in times of economic hardship. Until such time as the private healthcare sector is able to do its part to remove this very real hurdle, accessibility for all employed individuals will remain nothing but a pipe dream.” 

In the context of medical schemes

“The NHI, as currently envisaged by the Bill, is a huge, complex, expensive and multi-decade program requiring considerable effort to be realised. NHI programs in other countries, including developed markets with significant financial and human resources, have taken 15 to 25 years in some cases for full roll out and implementation, with many changes in direction along the way. We support an NHI model that aims to eliminate the socio-economic divide by strengthening and improving the healthcare system for all South Africans based on need, rather than affordability,” said Noach.

“There are assets, skills and valuable experience available in private healthcare in South Africa, which can be leveraged to ensure the success of the NHI roll out. So, the Bill creates an opportunity for collaboration in this regard. Health professionals are unquestionably the most valuable resource to our health system, and should be central to a consultation process, planning and development. There is a clear need for rigorous human resource planning, which is a key pillar of the Health Compact. This includes understanding the availability of existing resources, planning for training requirements and also ensuring appropriate use of resources. It also requires transparency and constructive engagement. There are immediate opportunities for using existing resources more efficiently and creating the kind of working environment with adequate clinical support that will lead to the retention of the key skills that the health system requires, whilst also ensuring a rich pipeline of health professionals for the future. The COVID-19 crisis has shed light on the opportunity to use technology and innovation to expand access to care,” added Noach.

What is needed right now?

“The ability to respond to increased demand from employers, medical schemes and healthcare consumers to lower healthcare costs, while broadening access to healthcare services is a pressing priority in the South African private healthcare sector. With only a fraction of South Africans employed in the formal and informal sector having access to healthcare cover, the implementation of NHI will come as a series of major shocks to the entire healthcare system. We must, therefore, be proactive in developing viable alternative streams of health support, which will go some way towards eliminating the inequity that exists in healthcare immediately, while ensuring that the basic healthcare needs of employees are met,” said Nauta. 

“What is needed right now are consummate leaders who understand the importance of offering employees efficient health cover. Not only will it stand businesses in good stead by reducing absenteeism and strengthening the bottom line, but it also builds morale, solidarity, loyalty and ultimately good labour relations,” concluded Nauta. 

“An effective and responsive healthcare system is vital to all South Africans, and ultimately to protecting economic growth. The Presidential Health Compact, signed in July 2020, highlighted that there are many existing opportunities for the public and private sectors to work together towards building a coordinated and responsive health system, including the need for human resources for health (HRH) planning, procurement oversight and strengthening health information systems. The Health Compact, therefore, provides a great framework for a middle-income country like South Africa to move towards a vibrant healthcare sector,” concluded Noach. 

Writer’s thoughts:
There are opportunities and there is room for collaboration. However, as Dr Nauta mentioned, without change, adaptability and innovative service delivery the important role that private healthcare currently plays will diminish. Do you agree? If you have any questions please comment below, interact with us on twitter at @fanews_online or email me - myra@fanews.co.za.

Comments

Added by Myra, 30 Jun 2021
Hi Peter, I agree, collaboration is likely to work.
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Added by Peter Dexter , 30 Jun 2021
Excessive regulations by government in healthcare, but also various other areas, especially labour law, creates uncertainty and resultant disinvestment. The result is rising unemployment, poverty and inequality. (Which is why NHI is so necessary) Although the objectives of NHI are noble, I believe they will result in further unemployment, an acceleration of the shrinkage of the tax base, and an exodus of healthcare professionals. The combined effect would produce exactly the opposite result to that envisaged by legislators. If the state DICTATES the terms it will be disastrous, but if they collaborate with the private sector to find SOLUTIONS, it is likely to work.
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