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FIA weighs in on NHI, healthcare brokers and medical schemes

02 March 2021 Gareth Stokes
Lizelle van der Merwe, CEO of the FIA

Lizelle van der Merwe, CEO of the FIA

We were among thousands of South Africans who listened attentively to the 2021 National Budget in the hope that our Minister of Finance would offer some insights into the future of healthcare provision. We fully expected the minister to explain how the roll out of the country’s National Health Insurance (NHI) programme would impact on the national budget in coming years. But he never mentioned healthcare funding at all, leaving it to commentators to go over the detailed statements released alongside his speech for further details. Our readers are interested in NHI because it will have a profound impact on the private healthcare sector and influence the long term sustainability of medical schemes and health insurance distribution.

A sustainable and transformed healthcare system

We were fortunate to spend some time with the Financial Intermediaries Association (FIA) in the week preceding the budget to find out more about the association’s thoughts on NHI and their various interactions with government in that regard. Lizelle van der Merwe, CEO of the FIA, used the opportunity to explain how the FIA had positioned itself during various representations on the NHI Bill. “At the outset we took a decision to contribute towards a sustainable, transformed healthcare system because we understand the importance of healthcare in society,” said Van der Merwe. The FIA’s proposal advocates strongly for a hybrid healthcare model built around both private and public healthcare providers and emphasises the role of the intermediary and the need for improved consumer education outcomes, among other points. 

Andre Jacobs,  member of the FIA’s Healthcare Executive Committee, said that the association took a different approach than most industry stakeholders when commenting on the NHI Bill. Instead of dwelling on unavailable details, the FIA interrogated whether the existing healthcare system was yielding efficient results and fair outcomes. “If one concludes that the existing private / public arrangement is inefficient, there is a strong case to be made for transforming the healthcare system,” said Jacobs, who has represented the FIA at various public hearings on the NHI Bill as well as on working groups at the Council for Medical Schemes (CMS). The association pointed out that much still has to take place before the NHI Bill became law. The Portfolio Committee of Health, after considering the various public inputs made to it on the Bill, must still make a recommendation to the National Assembly. From there the Bill needs to go to the National Council of Provinces. 

Introducing minimum benefits and primary care

The FIA believes strongly that South Africa needs a different solution to transform the country’s healthcare system. It has made oral and written submissions on the Bill which include constructive proposals for a future healthcare solution underpinned by a minimum benefit package focused on primary care. “Our proposal suggested creating community work opportunities that will improve health outcomes and the introduction of a mandatory community service where school learners will, for a certain period of time, go and work in the healthcare system,” says Jacobs. The idea is to create meaningful work experience, raise awareness of the importance of healthy lifestyle choices and rekindle a sense of national pride amongst the youth. 

What about the future of FIA members who give invaluable advice to the country’s medical scheme members? we interjected. We have all heard the worrying comments from the Minister of Health that medical schemes will only be allowed to offer supplementary healthcare services that are not covered by NHI. FAnews was also interested to know how an association could give input to a solution where there were still so many unknowns. At the time of writing, it was not clear how much NHI would cost, what benefits individuals would receive from the state-run system and what lay in store for key stakeholders such as healthcare brokers and medical schemes. 

A critical role for SA’s healthcare brokers

Jacobs said that the role the broker performed in the current healthcare system will become more critical in a transformed system. “A broker must advise clients about their choices, obligations and rights; educate clients about the functioning of the various health insurance products available to them; and protect clients by ensuring they receive the benefits and treatment due them,’ said Jacobs. “I can guarantee you that there is a role to be played by intermediaries in ensuring the rights and duties of members under NHI”. 

The FIA expects that consumers will need help to enshrine their legal rights whether they received healthcare services through a state-run NHI, a private sector medical scheme or a hybrid private / public model. It is also important to remember that the FIA member, being the broker, serves at the behest of his or her client, the end-consumer of health insurance. Whichever way NHI plays out, there will be a need for broker-assisted advice covering both the new system and the evolving healthcare insurance landscape that will offer additional covers to supplement it. Brokers will have to step in to navigate individual NHI members through the evolving healthcare environment and add value by ensuring that clients are adequately covered. 

Making tough decisions in an uncertain environment

The absence of details is what worries FAnews most, because it is difficult to plan in an uncertain environment. What happens, for example, if brokers end up being roped in as employees of the NHI? And how do you ensure that the broker participates in the future system along the same lines as presently? 

“It was never up to the FIA to go address the detail of the NHI proposal, those details are not yet known,” said Van der Merwe. “Our role in the debate was to provide comprehensive proposals that incorporate the important role of the intermediary”. The risk in taking a ‘detail first’ stance, according to the association, was that its voice would not be heard. “We do not want to sit back and wait to see what the outcome is but rather assist in playing a constructive role in guiding the thinking on NHI and driving the strong message of a collaborative approach between the private and public sectors,” she said. 

“The FIA took an early decision to engage constructively on NHI,” said Jacobs. “It is our responsibility to our members to work with government to find a sustainable solution where more people can have access to quality healthcare”. Although the FIA remains focused on constructive solutions it will not do so to the exclusion of reason. So, for example, where the Bill proposes to give the Minister full powers to appoint people, the association argued that appointments should be made with input from civil society and organised labour instead. Van der Merwe concluded that the demand for intermediary services could increase under NHI. The future requires agile businesses a to offer meaningful healthcare advice in an increasingly virtual world. 

Writer’s thoughts:
An almost hour-long chat with the FIA left a new appreciation for the difficulty of securing brokers’ futures in an evolving financial services environment. It will be some time before the final implantation of NHI is achieved; but brokers can rest assured their association is going to bat for them. We would love to hear your thoughts about brokers’ evolving roles as we power towards NHI? Please comment below, interact with us on Twitter at @fanews_online or email us your thoughts mailto:[email protected].


Added by Ellen, 02 Mar 2021
good work to the FIA and the CEO for a great work you doing in the financial services industry
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Added by Rob Lansdell, 02 Mar 2021
Well done Lizelle, Andre and the FIA team - please keep up the good work and engagement with stakeholders. We look forward to a workable solution to the universal healthcare question
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