NHI: Snail pace to ensure smooth implementation

01 August 2013 Jonathan Faurie. FAnews

When Government made the announcement that it would be introducing the National Health Insurance programme, there was a collective gasp from many South Africans as they were suddenly wading into seemingly unfamiliar waters. However, when one considers that every developed nation in the world has a NHI programme in some way, shape or form, the South African model is long overdue and if managed correctly can put the country on the map as one of the best providers of healthcare in the world.

One of the major concerns which is paramount to most South Africans was the fact that the programme opens the door for another Medupi situation where there are grand plans, which is poorly managed. This does not need to be the case. Heidi Kruger, Head of Corporate Communications at the Board of Health Care Funders (BHF), says that Government could utilise the infrastructure and expertise which exists within the private sector.

"We believe that there is a wealth of knowledge, resources and infrastructure with vests in the private healthcare sector which could be utilised in implementing and managing a National Health System. We believe that, like the Gautrain model where it was a government initiative and which is outsourced to the private sector to maintain and run, the private funding sector could manage and run the NHI. This would provide more certainty to the market," Kruger says.
Educating the nation

A lot of the uncertainty surrounding the NHI stems from the fact that the public needs to be educated about it. This however is also a difficult task considering that there is currently very little information about it which is available to the public.

"Whilst we are awaiting the White Paper on NHI, it is worth looking at other national or social health systems. There are several key principles which the current medical scheme population will need to consider. The first is that the NHI will almost certainly be based on income cross subsidization and risk cross subsidization. This means that higher income earners will contribute more towards the programmes implementation than lower income earners. And because the risk pool would include the entire population, there will be cross subsidization between the young and healthy members and elderly and sick members.”

What is clear from the Green Paper, released in 2011, is that the intention of the NHI is to include a comprehensive benefit package, using both the private and the public sector providers and facilities. Not only will it finally bring South Africa on par with other developed nations such as the USA and the UK, but it will also entrench South Africa’s position in Africa as one of the fastest growing nations on the continent where many countries can base their model on ours. However, it is unlikely that we will see a fully-fledged NHI within the next 14 years.

Kruger warns though that the public must not expect this to happen overnight. Government has already pointed out that the programme will only be fully rolled out over the next 10 to 20 years, and a lot of clarity needs to happen in the industry before then.
"Currently, the medical insurance industry is sitting without any tariffs. This needs to change as the ‘free for all’ situation that the industry currently finds itself in is completely unsustainable. Government must also establish a framework whereby medical aid companies can negotiate with doctors on a meaningful basis with regards to rates, and Government must make a concerted effort to move towards a situation whereby it makes medical insurance compulsory. Currently only 16% of the South African population is covered by insurance, this needs to change.”

Meaningful discussions

It is clear that a lot of legwork needs to be done in the industry to effect the smooth implementation of NHI. This requires meaningful discussions involving all relevant stakeholders who must play a constructive and supportive role. The annual BHF Southern African Conference provides a platform for stakeholders to reflect on and discuss these issues.
This year marks the 14th edition of the conference and was held in Cape Town on August 18 to August 21. Kruger says that the conference is growing not only because of the quality of the speakers, but because it is the one of the main forums in the industry whereby issues can be dealt with on a meaningful level.

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