In the build up towards the Board of Healthcare Funders (BHF) conference, key healthcare stakeholders discussed the proposed National Health Insurance (NHI) at the Engage Forum, hosted by Metropolitan Health Group and Qualsa, in Cape Town recently.
Nolwazi Gaza, Health Specialist at the Development Bank of SA (DBSA) discussed the Roadmap for the Reform of the South African Health System.
As she pointed out, South Africa has parallel, but unequal private and public healthcare systems and the disparity between the two perpetuates inequalities in our society. The public system serves the vast majority of the population, but lack of funding and staffing remain major challenges. Only roughly 20% of citizens make use of the private system.
NHI, which has its origins in the ANC Health Plan of 1994, is seen as a response to the inadequacies of our health system. In 2005, 8,5% of GDP was spent on healthcare, of which approximately 42% was government expenditure. Although South Africa is internationally recognised as a middle-income country, the Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR) are much higher than expected.
Blum Khan, CEO of Metropolitan Health Group, commented that according to the World Health Organisation's Overall Health System Performance report, our healthcare system is ranked 175th out of 191 countries.
“This should definitely spur us on to change the system for the better,” he said.
Khan outlined his six-point view on how NHI could work in South Africa, based in part on his experiences of the implementation of NHI in Australia, where he lived previously.
“First of all, a partnership between the public and private sector is absolutely critical to the whole process,” Khan explained. “Secondly, all SA residents will play a role in NHI. This will be phased, with employed citizens paying first and then the self-employed coming on board. Thirdly, citizens who currently have private healthcare will pay more.”
In his fourth point, Khan mentioned that NHI hospitals should be run and administered by private contractors, although he admitted that the idea might not be easily accepted.
“Finally, licensing needs to change and the private healthcare sector will need to be consolidated,” Khan said. “South Africa is likely to follow a single-payer model and over time there will be a further consolidation of medical aid schemes.”
Khan also highlighted the scale of opportunities that will be available to administrators, GPs, specialists, hospital operators and pharmacies.
“We surmise that phase one of NHI will bring seven million additional lives into healthcare, which will create a wealth of opportunities,” Khan stated. “Pharmacies and specialists will gain significantly and hospital operators will be able to bid for new PPP opportunities.”
He also discussed possible threats, such as potential downward pressure on the market and the fact that healthcare may be taken over by a state agency in the future.
Roly Buys, Director of Funder Relations and Contracting for Medi-Clinic, provided interesting insights into how the nation can ‘build an NHI house’.
“We need a health status analysis for the nation,” he emphasised. “The questions are which organisation will take on the responsibility of building capacity and ensuring transparent reporting, and how much it will cost.”
He also focused on the need for training of staff and facilities, affordability and payment reform.
“Globally, out-of-pocket expenditure has been used to fund care privately. We can expect this market to remain until public services and facilities meet client expectations,” he said. “We also need to recognise that the economy has to grow to ensure that a greater portion of the population can contribute.”
Esmé Prins, Director of Corporate and Private Sector at Benguela Health, provided an update on the latest legislative developments in the health sector.
She said that government wants to implement NHI within the next five years, but felt that the time frames were overly optimistic and are out of kilter with what has been happening internationally.
“However, we need to start somewhere and this is a peg in the ground. It indicates a definite commitment from government in terms of the urgency of the situation, but I think we will need more time,” she added.
There may still be many questions and much debate around NHI, but there is one certainty: the healthcare system will change. “This journey began in 1994. Fifteen years down the line, we have made significant process but many key failures are still pervasive,” Khan said in conclusion. “I think everyone agrees that our current healthcare system is not sustainable. Yet, political will seems to be in place. There will be potholes along the way, and we should proceed with caution, but ultimately NHI is here and we should be ready for it.”