Timing of medical schemes legislative amendment risks putting the cart before the horse.
The release of the National Health Insurance Bill, the Medical Schemes Amendment Bill and the provisional findings of the Health Market Inquiry, all within the space of three weeks, has provided much food for thought about the future of South African healthcare.
“A considerable amount of time, resources and expertise have been invested in the Competition Commission’s Health Market Inquiry [HMI],” says Mark Arnold, Principal Officer of Resolution Health Medical Scheme.
“In the four-and-a-half years since the HMI began, it has had input from every relevant stakeholder. The inquiry represents the most comprehensive assessment of the private healthcare sector ever undertaken in our country.
“With the HMI’s final report due for release in November, however, there is a risk that the full benefit of these insights could be lost due to the timing of these inter-related developments, as the period for submissions on Medical Schemes Amendment Bill and the National Health Insurance Bill close in September.”
Arnold points out that there is significant risk that the regulatory environment being created through the legislative amendment process currently underway could conflict with the lessons learned in the course of the HMI’s work, which will only be fully apparent on the release of its final report.
“As it stands, the HMI findings might be considered when fine tuning the proposed amendments to medical schemes law. However, far greater value could be added if the final HMI findings and recommendations are embraced and incorporated as the foundation for the amendments in the creation of a fresh approach to healthcare for the country.
“Closing the submission period on the Medical Schemes Amendment Bill, which specifically deals with the private healthcare sector, before the HMI’s final report is available is analogous to putting the horse before the cart.
“Such an approach squanders the opportunity to strengthen legislation with the full benefit of wisdom garnered during the lengthy and expensive inquiry and the best chance we have of making informed decisions that will shape the future of healthcare in South Africa for all.”
Andre Jacobs, an executive at ASI Financial Services, adds: “The Minister of Health requested that the Competition Commission conduct the HMI, which, after several delays, published its preliminary report for public comment on 5 July 2018 and the public and stakeholders have until 7 September 2018 to make comment. The HMI Panel will then consider all the recommendations and comments and is expected to publish its final recommendations by 30 November 2018.
“Considering public comment on the Medical Schemes Amendment Bill (‘MSAB’) must be provided before 20 September 2018, this not only eliminates the opportunity to include the relevant HMI findings in the MSAB but also duplicates effort and threatens to fundamentally weaken public comment.
“In addition, the Constitution and the Promotion of Administrative Justice Act (PAJA) prescribe that this process needs to be fair and there is a concern that excluding the findings of the HMI may not be aligned to this.
“It is our view that it may be prudent for the Minister to consider withdrawing the Medical Schemes Amendment Bill until the findings and recommendations of the HMI are finalized,” Jacobs asserts.
“Market experts have been involved in, and unanimously commended the HMI’s work in reviewing the private healthcare market. Even if certain commentators dispute some of the specific conclusions and recommendations, overall appreciation of the inclusive and comprehensive process is widely accepted.
“Therefore, the attention of society and stakeholders should be to focus on the HMI report and the comment leading up to 7 September 2018. This will enable society to further participate in a meaningful debate on the industry as access to healthcare is of national importance,” Jacobs adds.
“Acknowledging that there is significant political pressure for legislative certainty that will pave the way for the full implementation of the National Health Insurance (NHI), Arnold notes that a better integrated process would be more likely to achieve a successful and sustainable new healthcare paradigm in the long run.
“If we are to overcome the challenges facing private healthcare – some of which also threaten to derail the goals of universal health coverage – we need to develop a balanced and well-informed piece of legislation, and this is a process that should not be rushed,” he adds.
“More haste in finalising the Medical Schemes Amendment Bill is likely to result in a framework that could hold up progress towards a truly progressive health system that will benefit generations to come,” Arnold concluded.