Graham Anderson, Principal Officer at Profmed
: News that US President Barack Obama has finally managed to pass sweeping changes, known as ObamaCare, to the healthcare system in America heralds useful lessons for South Africa with the looming implementation of ‘ZumaCare,’ or National Health Insurance
According to Graham Anderson, Principal Officer at Profmed, the medical scheme that caters exclusively for graduate professionals, healthcare reform in the US has proven very controversial as it takes personal choice out of citizens’ hands and hands it to the government. “This is not dissimilar to the current situation in South Africa with the government planning to introduce universal healthcare that must be paid for by all workers, regardless of whether they already have some form of health insurance.”
“We strongly support the principles behind ZumaCare – quality healthcare should be available to all South Africans. However, whether the current proposal is viable is open for debate as it will be extremely difficult to implement, particularly in a 14-year timeframe. What is most likely to happen is that the current public healthcare system will simply be improved over, thereby providing better healthcare to the lower income population. This in itself is a very good starting point, as some form of social health system is desperately required.”
Anderson notes that one change proposed by ObamaCare was that individuals not covered by employer- or government-sponsored health insurance plans are now required to maintain minimal essential health insurance coverage or risk paying a penalty - unless they can prove financial hardship. “This has proven to be one of the most controversial elements to the US reform. However, this development would be highly unlikely to occur in this country. The reality is that most people in South Africa, who have the financial means to do so, already opt to have some form of healthcare insurance in place, as there is a justified fear among many South Africans of having to attend a state hospital due to the current state of government hospitals.”
He says other changes being introduced in the US do, however, offer lessons that ZumaCare can take heed of. “One section of ObamaCare requires all health insurance plans to cover both immunizations and preventive care with the idea being that if everybody takes these precautions to prevent disease, it will cost health insurance companies far less in the long run.”
“This is a very astute move on the part of the US. Preventative care is an essential component to a well-functioning healthcare system as it reduces the financial burden on the state, healthcare providers and funders.”
One aspect to the reform that will have significant ramifications for the private healthcare industry is the removal of pre-existing clauses from all health insurance plans by 2014. “What this means is that health insurance companies will no longer be able to end or refuse to renew coverage unless you have misrepresented yourself or your medical situation, or if fraud has been committed.”
“Like ObamaCare in the US, ZumaCare is also proving controversial with many South Africans. However, whether it is introduced in its current form or not, it is critical that we start implementing measures to improve our ailing state healthcare system before it deteriorates any further,” concludes Anderson.
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