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The quiet before the storm

19 May 2009 Gareth Stokes
Gareth Stokes, FAnews Online Editor

Gareth Stokes, FAnews Online Editor

Regulators in the financial and healthcare sectors have gone quiet of late. The momentum that accompanied initial proposals for South Africa’s National Social Security System waned as the ruling party readied itself for post-Polokwane elections. Meanwhile, proposals for a National Health Insurance (NHI) solution remain in their infancy.

What can we expect as the new government settles in? Will things hot up as ministries assign their priorities for President Jacob Zuma’s first term in office? FAnews Online expects major policy acceleration on both fronts. The reason: Cabinet ministers driving healthcare, education and to a lesser extent finance (through the new economic development ministry) have the fate of the country’s poor at heart. If recent news from the healthcare industry is anything to go by, stakeholders will have to brace for unprecedented change!

A five year NHI implementation

Is government’s stated goal of implementing a NHI solution in the next five years feasible? This question was put to Dr Humphrey Zokufa, managing director of the medical schemes representative body, the Board of Healthcare Funders (BHF) in a recently published Medical Chronicle interview. Zokufa didn’t provide a direct answer. Instead he alluded to the African National Congress manifesto which calls for the process to be “implemented in phases within five years.” He suggests there is no need for each of these phases to be completed within that time. Timing issues aside, there are many stakeholders who argue against a NHI implementation at any cost. They say it could signal the death knell for the private healthcare industry, particularly private medical schemes.

Writing in Sake Rapport, Letitia Watson notes that “schemes are concerned that the proposed national system will restrict the activities of medical schemes to such an extent that they will not be able to provide cover for any services that fall within the NHI framework.” But the argument for a separately funded healthcare system falls flat too. Zokufa say that the NHI “made provision for social solidarity and cross-subsidies where the healthy subsidise the sick, and the young the old.” But South African taxpayers already make this sacrifice by contributing money to the state – billions of which flow through the department of health to provide medical assistance to all-comers. The facilities and services provided from this revenue leave a great deal to be desired. We wonder how government proposes running health insurance with the department’s rather dismal track record going back more than a decade!

NHI systems don’t guarantee better healthcare for all. In South Africa we’ll migrate from the current ‘good service for a few and abysmal service for the rest’ to ‘abysmal service for all’. That’s pretty much what happened in the United Kingdom. Their ‘prize’ NHS service is continually in the spotlight for poor basic services on the one end of the healthcare ladder and long waiting lists for theatre procedures on the other. The trend in the UK is to return to private healthcare despite mandatory contributions to the NHS.

Representative bodies should be impartial

Returning to South Africa, the latest proposals have caused ructions in the medical schemes space. And tensions have been exacerbated after some BHF members questioned how Zokufa could represent their interests impartially while serving on the ruling party’s NHI task team. Allegations surfaced earlier this year that BHF member funds were being used to bankroll a political party’s healthcare policy rather than representing member interests. Under these conditions it was hardly surprising when the country’s largest open scheme, Discovery Health, announced it would terminate its membership of the BHF. Discovery hopes to join (or establish) a new representative body with other disgruntled BHF members.

It’s still not clear whether the ‘split’ will be permanent. But the ructions have hit home. Zokufa says “the resignation of Discovery has affected BHF’s revenue stream and compromised our operations.” He wasn’t sure how sustainable the body would be without Discovery’s participation.

Editor’s thoughts:
The best weapon for medical schemes in the ongoing debate with government on healthcare reforms would be to present a united front. It may thus have been prudent for Discovery to attempt to re-align the representative body with the medical schemes industry rather than taking the ‘divide and conquer’ route. Do you think it is appropriate for the Board of Healthcare Funders’ managing director to sit on the ANC NHI task team? Add your comments below, or send them to gareth@fanews.co.za

Comments

Added by Henk, 19 May 2009
Being on the ANC NHI task team is not necessarily a problem, but he needs to represent the views of the BHF and not that of the ANC.
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