Tag: NHI

Categories : Healthcare Politics and RegulationsTags :

With Elections and NHI, This is a Big Year for Healthcare in SA

On By ModernMedia

By Marcus Low

South Africa is barrelling towards its most consequential and most competitive national and provincial elections since 1994, expected to take place in May. That the ANC’s share of the vote, will be further eroded this year seems inevitable, given ongoing power cuts, failing railways, water management problems, high crime rates, and dysfunctional basic education and public health systems.

Covering elections is tricky at the best of times for media houses. At Spotlight, we plan to follow the advice of Jay Rosen, journalism professor at New York University, to focus on reporting “not the odds, but the stakes”. As far as the odds does go, however, it seems likely that the ANC – alone or in coalition – will govern nationally, but they could lose power in the country’s two most populous provinces, Gauteng and KwaZulu-Natal.

The stakes in these two provinces could not be higher when it comes to healthcare. The day-to-day running of our public healthcare system is after all the domain of provincial health departments.

Limping from crisis to crisis

Take Gauteng. From alleged health department corruption worth more than R1.2 billion in 2007/2008, to the Life Esidemini tragedy of 2016, to more recent issues such as the lacklustre response to alleged corruption at Tembisa Hospital, ongoing problems with food and security contracts, and the persecution of whistleblowers like Dr Tim de Maayer, the province’s health department has stumbled from crisis to crisis under the ANC for well over a decade now. New starts under new members of the executive council (MECs) and heads of department have been a dime a dozen, but if anything, the quality of governance has decayed over time. What is at stake is literally basics like whether there is sufficient food available for people in hospital.

There is, of course, no guarantee that this atrocious situation will be turned around if, for instance, a multi-party coalition of the DA, Action SA and others run the province – but the prospect of such a change certainly is intriguing. Just imagine the DA’s Jack Bloom having a go as Gauteng’s MEC for Health after decades of holding other MECs and heads of department to account from the sidelines.

The future of NHI

The year’s other headlining health story seems set to again be National Health Insurance (NHI), which promises healthcare for all – employed or unemployed – South Africans, permanent residents, refugees, inmates, and specific categories of foreign nationals. After making it through parliament at the end of last year, the NHI Bill is likely to be signed into law by President Cyril Ramaphosa any day now. Much of the bill won’t come into effect for quite some time, and we are sure to see several court cases challenging its constitutionality. There is also an outside chance that later this year the balance of power in parliament could shift against NHI, or at least certain elements of NHI. It is not too much of a stretch to say the future of NHI is one of several important things on the line at the ballot box.

Also at stake in the elections is government’s response to seemingly intractable problems like South Africa’s shortage of healthcare workers, budget shortfalls, and health sector corruption. It would be naïve to think a change in power will solve these problems overnight – much of the world is struggling with shortages of healthcare workers and South Africa’s budget restraints are all too real, but some will argue that a change in power may nevertheless be a necessary first step given the extent to which all three of these issues have been allowed to drift in recent years. There is certainly an argument to be made that the current lack of progress is rooted in a lack of state capacity and that the lack of state capacity, in turn, is a consequence of the ANC’s explicit policy of cadre deployment.

Whether or not voters again back the ANC, some specific questions should provide a good gauge of progress in 2024. Will we finally see convictions for the alleged corruption uncovered by public servant Babita Deokaran? Will government publish an implementation plan for addressing our healthcare worker crisis (we already have a good strategy) and, this is the key, put money and political capital behind its implementation? Will the new parliament pass a good State Liability Bill (which could help reduce the state’s liability for medico-legal claims) and finally get round to amending South Africa’s Patents Act to better balance medicine monopolies with the right to health (as set out in a policy adopted by cabinet back in 2018)? Will the establishment of the National Public Health Institute of South Africa remain stalled? Will government continue to ignore recommendations from the Competition Commission’s Health Market Inquiry on how to better regulate private healthcare in South Africa (the commission’s very impressive report was published in 2019)? Will the new health MECs and heads of provincial health departments appointed after the elections bring real change?

HIV, TB and NCDs

The National Department of Health has generally produced good HIV and tuberculosis (TB) policy over the last decade or so. In some respects, those policies have been well implemented – think the massive amount of HIV testing done in the country, in other respects they have been undermined by the general dysfunction in the public healthcare system – think long queues, staff shortages, and poor TB screening and infection control. Some innovations, like pills to prevent HIV or new TB treatments, could have been rolled out more quickly and better marketed to users.

At stake in the elections is thus not so much whether we produce good policies in areas such as HIV, TB and non-communicable diseases (NCDs), but whether we will get the leadership we need to ensure better and faster implementation of those policies.

On the HIV front, we will be keeping a close eye this year on the ongoing rollout of HIV prevention pills. While the rollout has gathered some momentum in recent years, the pills are generally still too hard to get hold of for those who could most benefit from it. Pilot projects should shed light on how to best make breakthrough new HIV prevention injections available in South Africa, but the high price of these injections is likely to mean the many young women who could most benefit from it won’t be able to get it.

New HIV figures from Thembisa, the leading mathematical model of HIV in South Africa, will be keenly watched this year since it will integrate recent findings from the  Human Sciences Research Council (HSRC) survey (which contained some unexpectedly positive numbers). On the negative side, the HSRC survey also indicated that condom use was significantly down in 2022 compared to 2017 – this while a recent HIV investment case found that condoms are the only cost-saving HIV intervention for the health system. Either way, the extent to which condoms are made easily available will remain an important measure of government’s commitment to fighting HIV, both now and after the elections.

Last year, we saw significant changes in how TB is tested for and treated in South Africa. In short, many more people became eligible for TB tests and eligibility for TB preventive therapy was dramatically expanded. How impactful these new policies will be this year will depend on how well they are implemented, which again brings us back to the ongoing problems of healthcare worker shortages and a lack of management capacity in most of our provincial health departments. Maybe then, in a context of generally reasonable HIV and TB policy, what matters is not so much what different political parties have to offer on these diseases specifically, but what they can do to improve the functioning of our healthcare system more generally.

That said, one notable thing with TB is that, despite South Africa having often made good TB policy and having played an important role in raising the profile of TB at the United Nations, TB has never really become a political or elections issue here in the way one might expect from a disease that claims over 50 000 lives, of mostly poor people, in the country per year. So far, there is no indication that any political parties are set to change this in 2024.

Finally, while the long-term trends with HIV and TB are downward, the trend with non-communicable diseases (NCDs) like diabetes and hypertension in South Africa is in the opposite direction. Government has set HIV-style diabetes and hypertension targets and published a national plan, but again there are serious questions about whether these plans will be implemented and whether the public health system has the capacity to offer the levels of testing, treatment and care that is required. Meanwhile, breakthrough weight loss medicines that made headlines in 2023 are likely to remain out of reach for most people in South Africa and interventions like the sugar tax will remain highly contested before and after the elections.

Whatever happens at the ballot box, one thing is clear, given the rising NCD threat, healthcare worker shortages, budget shortfalls, and endemic corruption, whoever is in power nationally and provincially after this year’s elections will have their work cut out for them. While we will not endorse any political parties at Spotlight, we do urge voters to consider what is at stake in these elections when it comes to healthcare. Part of the picture will of course be painted by political party manifestos (which we will analyse in detail in the coming months), but as important as the policies, is the track record of what parties have done when they’ve held power. Whether in Gauteng, the Western Cape, or nationally, voters will hopefully send a clear message on whether or not they think those currently in power are on the right track.

*Low is editor of Spotlight.

NOTE: Spotlight is editorially independent and is not affiliated with, nor does it endorse any political parties. Spotlight is a member of the South African Press Council.

Republished from Spotlight under a Creative Commons licence.

Source: Spotlight

Categories : Healthcare Politics and Regulations Medical IndustryTags :

Does NHI Spell the End for Medical Aid and Gap Cover?

On By ModernMedia
Photo by National Cancer Institute on Unsplash

South Africa’s National Health Insurance (NHI) Bill would, if passed in its current form, completely disrupt the medical sector in the country and would inevitably reshape the role of medical schemes as well as gap cover.

However, the implementation of NHI does not necessarily mean that medical aid and gap cover will no longer have a role to play, because there are many possible scenarios in which they will continue to be an important part of the landscape. It is important to understand your current coverage from both a medical aid and gap cover perspective so that when the NHI does come into effect, you can make an informed decision that will be best for your needs.

A long road ahead

Given the potential for the current NHI Bill to face legal challenges, we are driven by a shared responsibility to safeguard the health and well-being of all citizens. The risk of lengthy court battles cannot be underestimated, as they may inadvertently prolong the uncertainty and affect the timely implementation of essential healthcare reforms. According to Andre Jacobs, Marketing Manager at The People Company and Vice Chair of the FIA Health Exco, these challenges include constitutional, funding, affordability, policy and supply-side demand issues.

“There are also conflicting points of information within the current Bill that need to be resolved. For example, in Section 33, the Bill states that once NHI is implemented, medical schemes can play a top up role, which could mean different things. It could imply that they may only provide cover for anything that is not primary care, or that they may only provide specialised dentistry cover or advanced oncology treatment,” says Jacobs. 

“However, if one reads the definition of a health service and a health product with section 2(a) of the NHI Bill, it states that all health services will be provided by the NHI Fund and that they are the single purchaser and provider of health services. Therefore, whilst section 33 provides a role for medical schemes, it would be impossible to operate,” he adds.

A matter of speculation

The reality is that it is yet to be determined what benefits the NHI Fund will provide. This means that the role of medical schemes, and therefore the role of gap cover, is a matter of speculation at present. The structure of the current medical scheme and gap cover range may need to be adjusted to align with the NHI offering that is enacted.

This may lead to the design of products moving toward a defined benefit structure where a particular medical intervention, such as a broken leg, has a defined benefit that is paid out irrespective of the amount of cover provided by the NHI. This amount could then be utilised to pay for a private procedure. It is also likely that high-cost treatments such as specialised dentistry or advanced cancer treatment or biological medicine will not be provided by the NHI Fund. However, the regulations post-NHI will dictate what can be offered.

“If we use overseas experience by way of example, there will be a role for both National Health and private insurance products, where the private cover will provide additional benefits to complement the base offering of the NHI. For example, we often see this as providing a fast track for certain elective procedures that a person may need to address due to personal circumstances,” says Tony Singleton, CEO of Turnberry Management Risk Solutions. 

Make sure you are covered in any eventuality

“The goal of expanding universal healthcare should be supported, but rather than abolishing private healthcare, South Africa should leverage the private sector to expand the level of universal health cover. We can develop a dualistic healthcare system with the same universal coverage elements based on social solidarity principles, with a healthcare system that is accountable to the communities it serves. Transitioning to a more equitable healthcare system demands not only sound policy decisions, but also a shared commitment to overcoming societal attitudes and cultural beliefs that might hinder progress,” says Jacobs.

Private medical schemes are an asset that should be leveraged to drive healthcare innovation and foster advancements for the broader healthcare sector, and the healthcare system needs to provide meaningful choices through an accessible, inclusive, and adaptable system that caters to the diverse needs and preferences of the population.

Gap products currently play an important role in protecting your financial wellbeing in the event that medical expenses exceed what medical schemes will reimburse. In the current landscape, where the future state of the NHI is uncertain, there is still a definite need for both medical aid and gap cover to ensure access to quality private healthcare. In addition, gap cover for the use of non-Designated Service Providers (DSPs) will continue to be important even after a National Health product comes into effect.

“Before making any decisions, it is important to understand the cover provided by your medical aid and to understand any limitations that your plan may have. To assist you with this, it is useful to have your financial advisor review your medical aid coverage. They will be able to identify the type of gap product that will be most complementary to your Medical Aid plan whilst at the same time understanding your family’s unique health and financial situation,” Singleton concludes.

About Turnberry Management Risk Solutions

Founded in 2001, Turnberry is a registered financial services provider (FSP no. 36571) that specialises in Accident and Health Insurance, Travel Insurance, and Funeral Cover. With extensive experience across healthcare and insurance industries in South Africa, Turnberry offers unsurpassed service to Brokers and clients. Turnberry’s gap cover products are available to clients on all medical aid schemes, as they are independently provided and are therefore transferable in the event of a change in the client’s medical aid scheme. Turnberry is well represented nationally, with its Head Office based in Bedfordview, Johannesburg with Business Development Managers in Cape Town and Durban. The Turnberry Team’s focus on outstanding client service comes from having extensive knowledge and experience in the financial services sector and is underwritten by Lombard Insurance Company Limited. Lombard Insurance Company Limited is an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.

Categories : Healthcare Politics and RegulationsTags :

NHI Bill Threatens All Citizens’ Constitutional Rights

On By ModernMedia

HFA outlines presidential petition to prevent decimation of the SA healthcare system

The NHI Bill presented to President Cyril Ramaphosa cannot be permitted, as in its current form, it will infringe the rights of all South Africans by destroying the South African healthcare system. The Health Funders Association (HFA) has petitioned the President to withhold assent of the Bill on constitutional and procedural grounds and intends to take the matter as far as necessary and to the Constitutional Court if need be.

“We have taken a strong stand by respectfully urging the President to withhold assent of the Bill, citing constitutional and procedural concerns that pose a significant threat to the integrity of the country’s healthcare system,” remarks HFA Chairperson Craig Comrie.

“Should the need arise, the HFA is prepared to escalate the matter to the courts. Our goal is to meticulously align the legislation with the authentic objectives of Universal Health Coverage and the principles enshrined in the South African Constitution.

“Our action in opposing the NHI Bill being signed into law protects the interests of ALL South Africans who will require healthcare in future, including the people we are duty-bound to safeguard through the medical schemes and healthcare administrators we represent,” Comrie says.

While expressing unwavering support for achieving Universal Health Coverage (UHC) in South Africa, the HFA questions Parliament’s endorsement of a bill that raises significant constitutional and procedural concerns and fundamentally cannot achieve a sustainable system of UHC.

Some of the primary concerns outlined in the letter include:

  • Constitutional concerns: The NHI Bill’s clear infringement on constitutional rights, particularly the right to access healthcare and freedom of choice for South Africans, and by implication, the right to life. The Bill is seriously flawed in that regard, undermining the rule of law.
  • Procedural concerns: Questioning the extent and effectiveness of public consultation during the drafting and review of the NHI Bill, where thousands of submissions resulted in no meaningful changes to the Bill, the HFA advocates for a more inclusive and consultative approach.

The letter implores President Ramaphosa to exercise the powers granted by the Constitution to refer the NHI Bill back to Parliament for review.

“In addition to petitioning the President directly as guardian of the Constitution, the HFA will oppose the NHI Bill in its current form through every possible avenue, including approaching the courts to set aside the Bill on constitutional and procedural grounds.

“The HFA will also seek a High Court interdict against implementation of the NHI Act until the merits of our case have been heard and ruled upon by the High Court.

Craig Comrie concludes, “It is with a heavy heart that we make this plea, urging the President to secure the rights and wellbeing of our people. We will persist to ensure that what is right triumphs in our nation. South Africa deserves leadership that prioritises the welfare of all of its citizens, above all.”

Categories : Expert OpinionTags :

The NHI Will Enforce the Use of EHRs – Resulting in a Steep Learning Curve for 60% Of SA’s GPs

On By ModernMedia
Photo by National Cancer Institute on Unsplash

As the development of the National Digital Health Strategy for South Africa (2019 – 2024) progresses, and the implementation of the National Health Insurance (NHI) implementation looms closer, it is clear that digital health will be the significant driver behind transforming our health system.

To date, a Health Patient Registration System (HPRS) Project has been started as an initial requirement before developing a template for what a patient Electronic Health Record (EHR) would include. Although the diagnostic, treatment and billing modules necessary for EHR’s within the NHI still need to be developed, one thing is certain: a complete, shareable, electronic health record for each patient will be key.  

How will it work

CompuGroup Medical South Africa, (CGM SA), a leading MedTech company describes an EHR as a portable, interactive, digital set of health records for a patient that assists healthcare providers in managing their care. The wealth of information provided in each EHR – from a patient’s medical history, demographics, their laboratory test results over time, medicine prescribed, a history of medical procedures, X-rays to any medical allergies – offers endless opportunities for real time patient care.

EHRs have the potential to play a role in closing the healthcare gap in South Africa by improving affordable access to healthcare and reducing health disparities. This is particularly important for marginalised populations who may have limited access to healthcare services.

GPs must adapt

Although the adoption of EHRs in South Africa is very low, with an estimated 40%* of healthcare professionals currently using digital health records in their practice or hospital, the looming National Health Insurance (NHI) Bill will encourage the adoption of EHRs, potentially improving care coordination, enhancing population health management, increasing efficiency and cost savings.

Globally, EHRs are responsible for improving efficiency by reducing duplicates within patient records, reducing unnecessary interventions such as repeat prescriptions and duplicate referrals. Of those using any form of healthcare technologies daily, 69% have found an improvement in the quality of care and 59% have seen a positive impact on patient outcomes.

Looking at the usage of technology by patients in South Africa, the statistics show that we lag behind the world average, with less than a third of our population using digital health technologies to track their health. It appears this is partially due to a distrust for the security of their health data and an affordability consideration.  

“One of the major challenges from a general practitioner perspective is that there is currently a lack of government policy and guidelines for patient data security, which in turn, affects their willingness to adopt EHRs as a standard,” says Dillip Naran, Vice President for Product Architecture at CGM SA.  

“If these hurdles can be overcome, the adoption of EHRs by GPs is predicted to have a positive impact on healthcare outcomes, and improve efficiency in the long run. The successful implementation and utilisation of EHRs will require careful planning, investment, and collaboration across the proposed NHI healthcare system, “ he goes on to mention.

Here are the seven main ways EHRs will contribute to the success of a National Health Insurance (NHI) programme in South Africa:

  • Improved patient safety: Reducing adverse effects related to medication prescription errors, dispensing errors, labelling errors and even, wrong site surgery.
  • Improved care coordination: Helping healthcare providers share patient information easily and more accurately, improving the coordination of care across different providers and settings, and eliminating the duplication of services.
  • Enhanced population health management: Providing data on health outcomes and trends to identify and address public health issues, such as disease outbreaks or health disparities, potentially informing policy decisions and resource allocation within the NHI.
  • Increased efficiency and cost savings: Reducing the administrative burden and streamlining processes, which can improve efficiency and reduce costs within the healthcare system.
  • Enhanced decision-making: Providing healthcare professionals with immediate access to relevant patient data, including medical history, allergies, medications, and test results. This information empowers clinicians to make well-informed decisions about patient care, leading to better diagnosis and treatment options.
  • Efficient claims processing: Streamlining the claims process, in the context of the NHI model, with the electronic submission of medical information leading to faster claims processing and reducing the chances of errors or fraud.
  • Early detection and management of chronic conditions: Flagging individuals who may be at a higher risk for chronic conditions, and monitoring the management of their care. 

It is important to realise that the implementation of EHRs can’t be expected to be solely responsible for closing the gap in healthcare. Other factors such as access to healthcare services, poverty and education need to be addressed, along with solving challenges such as data privacy, security concerns and improving digital literacy within certain previously disadvantaged population groups.

By Andrea Desfarges on behalf of CompuGroup Medical SA.

*. *Statistics taken from “Adapt as you adopt: Adjusting to digital health tech to drive access to care” by Jasper Westerlink, Dec 2019.  

Categories : General Interest Healthcare Politics and RegulationsTags :

Universal Healthcare is Possible in Our Lifetime

On By ModernMedia

Universal Health Coverage Day calls on us to reflect on the progress that we have achieved in providing healthcare for all. As the health and pharmaceutical industries, it is time to question if our strides in achieving healthcare for all are successful and identify areas for improvement. The theme “A Time for Action”, speaks to the urgency of healthcare access regardless of socioeconomic status, age, race or demographic. It is not an ambitious dream and can be attained in our lifetime, writes Bada Pharasi, CEO of the Innovative Pharmaceutical Association of South Africa (IPASA). 

Universal Health Coverage (UHC) means access to primary healthcare for everyone. In South Africa, this is referred to as  National Health Insurance (NHI). Regardless of its name, the objective remains the same – to ensure that all citizens, regardless of where they live or their socioeconomic status, have access to healthcare.

A 2021 report released at the Africa Health Agenda International Conference (AHAIC) revealed that 615 million, or 52%, of the people in Africa, did not have access to the healthcare that they needed¹. It was also estimated that 97 million Africans face catastrophic healthcare costs, which push 15 million people into poverty every year¹. 

The effective implementation of UHC would mean that no person would have to go without appropriate healthcare. It would also mean that no person would have to undergo financial strain to receive treatment for ill health.

UHC covers a spectrum of health needs from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course². In 2015, 193 United Nations (UN) member states agreed on the 2030 Sustainable Development Goals (SDG). These goals are aimed at seeing an end to poverty and a sustainable future by 2030², and ensuring health coverage for all is an integral part of reaching these goals. 

The World Health Organization (WHO) believes that UHC can be achieved by using the primary healthcare approach as it remains the most accessible, inclusive and cost-effective method to reach the majority of the population². 

Globally, as many as 72 countries have included UHC in their national healthcare systems. The countries where UHC has been the most successful include Canada, Australia, and several European countries, such as Switzerland and Sweden. It is from these countries that we can glean valuable lessons on the importance of strong healthcare systems, well-trained healthcare professionals and a cohesive relationship between governments and the private sector³. 

Ensuring a healthier nation may seem like an exorbitant mission. However, when we consider that a healthier population will be beneficial to the economy, it makes for a worthwhile investment. The World Bank adds that UHC allows countries to make the most of their strongest asset: human capital. A nation in good health is one where children can go to school and adults can go to work⁴. 

There is a common perspective that for a country’s overall health to improve, its economy must improve first. This idea fuels the understanding of why low- to middle-income countries have such poor healthcare infrastructure. The World Bank offers an alternative perspective, suggesting that when a country’s overall health improves, so will its economy. This as more citizens will be able to contribute to its economic growth and the workplace⁵.  

Some of the reasons why the adoption of UHC in African countries has seemed to stall include inadequate financial and technology support, limited pharma manufacturing companies, and unclear policies and regulatory frameworks⁶. 

In South Africa, the greatest hindrance to people receiving the healthcare they require boils down to numbers. With a population of more than 60 million people, there is a greater need for healthcare than there is capacity to meet the demand⁷. 

At IPASA, we believe that healthcare is a basic right and that citizens in any given country should be given the necessary access to healthcare. We understand that working with key stakeholders, such as the government, is critical to the success of universal healthcare. Our ongoing work with patient advocacy groups ensures we understand what patients need from a treatment perspective.

We recently attended the Access Dialogue conference with patient advocacy groups including Rare Diseases South Africa and Campaigning for Cancer to gain an understanding of some of the concerns faced by patients and share insights on the proposed NHI Bill. 

IPASA believes that an adequate supply of medicines is a critical pillar of any healthcare scheme, and the NHI is no different. For the NHI to succeed, it must be backed by a sustainable healthcare sector to ensure the security of healthcare provision and medicine supply.

To this end, the NHI must allow for a flexible, responsive pricing model that includes alternative/innovative reimbursement models to cover the cost of medicines and health products. This allows responsiveness to the needs of geographical areas, quality and levels of care, and negotiations directly with healthcare providers.

Healthcare for all can only be achieved by the joint commitment of the health and pharmaceutical industries, government stakeholders and patient advocacy groups for the benefit of patients. No person should be faced with the obstacle of finance at a time when they need healthcare: providing healthcare for all results in a healthier society and healthier world for us all. 

References:

  1. https://healthpolicy-watch.news/only-half-of-africans-have-access-to-health-care/ 
  2. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc) 
  3. https://wisevoter.com/country-rankings/countries-with-universal-healthcare/#:~:text=The%20countries%20with%20the%20highest,comprehensive%20coverage%20of%20healthcare%20services.
  4. https://www.worldbank.org/en/topic/universalhealthcoverage 
  5. https://widgets.weforum.org/outlook15/10.html 
  6. https://www.iqvia.com/locations/middle-east-and-africa/blogs/2023/01/getting-quality-medicines-to-patients-faster-in-africa-how-to-solve-for-access-issues 
  7. https://www.wits.ac.za/covid19/covid19-news/latest/healthcare-in-south-africa-how-inequity-is-contributing-to-inefficiency.html
Categories : Healthcare Politics and RegulationsTags :

BHF Responds to the Imminent Approval of the NHI Bill

On By ModernMedia

The National Health Insurance (NHI) Bill was approved by the National Council of Provinces today and is due to be signed into law by the president shortly after. The Board of Healthcare Funders (BHF) is deeply disappointed. We are not happy with the various sections of the Bill. Despite submissions to government in this regard, the recommendations of the BHF and other stakeholders have largely been ignored and the bill is being passed virtually unchanged from its originally drafted form.

While the BHF fully supports the concept of universal health coverage (UHC) as defined by the World Health Organization (WHO) and believes that it must be a strategic imperative for all those directly or indirectly involved in healthcare, it does not support the NHI Bill in its current form. The bill restricts medical schemes to the provision of complementary cover potentially rendering them unsustainable, further to which the enormous economic value that medical schemes currently add to the health sector would be lost to South Africa if the bill goes ahead unchanged, BHF strongly believes this section should be removed as well as all references to complementary cover contained in the bill.

Additionally, a number of the Bill’s provisions are unconstitutional. These were detailed in the BHF’s submission to government. South Africa needs a strong, vibrant private health sector because government resources will never be unlimited. . The incredibly wide powers it bestows on the Minister of Health grossly undermine the board of the NHI fund and its accountability. The power of the Benefit Advisory Committee to determine health benefits under NHI similarly undermines this accountability. In addition, the BHF is perturbed by the demonstrated inability of the state to adequately operate national public entities and state-owned enterprises, as well as the endless levels of relentless corruption in the public sector.

Other concerns

The Bill allows the Minister of Health and the NHI fund to issue directives that override all other legislation, except the PFMA and the Constitution, including legislation specifically mandated by the Constitution.

There are proposed amendments to the Medical Schemes Act that unfairly discriminate against pregnant women. 

In many instances, the language of the bill creates significant legal uncertainty, which is itself unconstitutional due to the principle of the rule of law upheld by the Constitution. The BHF provided specific examples of this in the body of its submission.

The NHI Bill allows the national sphere of government to encroach on the geographical, functional and institutional integrity of provincial governments. This is not permitted by Section 41 of the Constitution.

The bill tries to dictate to the President in Cabinet (the National Executive) what new legislation must be made or how to amend existing legislation. This is also unconstitutional, as the Constitution itself grants the National Executive its powers. Nothing can change this except an amendment to the Constitution.

The registration system proposed by the bill creates unconstitutional barriers to access to health care that do not currently exist. The certification, accreditation and contracting system proposed by the bill is unwieldy, and it too will create unconstitutional barriers to access to health care that currently do not exist. Both these points are explained further in the body of the BHF’s submission.

Dr Katlego Mothudi, BHF CEO, underscores these serious implications of the bill’s being passed unchanged. “We have consistently given input into this proposed law and are disappointed that our concerns and those of other stakeholders appear not to have been considered or even tested. The bill in its current form will have a negative impact on healthcare access for everyone. There are many areas of uncertainty that have not been clarified, not least with regard to funding and affordability. We are also concerned specifically that the bill may prejudice the rights of women,” he says. “The proposed amendments to the Medical Schemes Act exclude access to pregnancy-related healthcare services for women who are medical scheme members. This means that these women would have to access reproductive health care from the public sector at their own cost, which is in conflict with the provisions of the National Health Act.

“The bill also has the potential for a wider negative economic impact. There is still uncertainty around how the NHI will be funded, but it will very likely be through additional taxation, something that will unavoidably have a detrimental effect on the economy at large – companies, individual employees and the general public – in the form of job losses. This phenomenon has already been discussed in various papers, including one published by the World Bank in 2001. It cited Colombia’s experience in this regard. A 10% increase in payroll taxes resulted in a 4.9% reduction in employment. Those who remained employed experienced a reduction in their disposable income, while the decrease in the overall number of employees saw a reduction in revenue from personal tax. Should the bill pass in its current form, South Africa will almost certainly experience something very similar.

“More specifically, this phenomenon will also impact the health sector. With medical schemes reduced to providing only complementary cover, not only will the schemes industry itself shrink, but all the other private entities it does business with, including hospitals, pharmaceutical companies and health practitioners,” he concludes.

Provided by the Board of Healthcare Funders

Categories : Healthcare Politics and RegulationsTags :

Glaring Voids Threaten SA’s Path to Equitable Healthcare

On By ModernMedia

A coherent, achievable path to universal health coverage now imperative

Glaring voids highlighted in submissions on the National Health Insurance (NHI) Bill threaten South Africa’s path to equitable healthcare access for all, cautions the Health Funders Association (HFA). The organisation has voiced its profound concern, emphasising the disconcerting sway of politics over the bedrock mission of prioritising the well-being of our nation within this critical healthcare deliberation.

“The practical barriers to successfully executing NHI as it is laid out in the Bill are hard to ignore, and yet the numerous concerns and suggestions raised in the consultation process have not been considered or implemented,” says Craig Comrie, chairperson of the National Health Funders Association (HFA).

“The clear shortcomings of the NHI Bill in terms of practical funding mechanisms and lack of collaboration with experienced health funders, among other aspects, have been overlooked for the most part, with only the Western Cape so far rejecting the Bill in its current form.”

The National Council of Provinces (NCOP) Committee on Health’s approval of the NHI Bill with insignificant edits does not address the numerous concerns raised in submissions made by the public and informed stakeholders, including the HFA, on behalf of its members.

The HFA is a professional body representing medical schemes and half of South Africa’s medical aid membership.

“There are constructive solutions to address the problems identified in the NHI Bill effectively, and it is not too late to fix the legislation. While the Bill is rushing towards the President’s pen to be enacted, the HFA respectfully appeals to the President to reconsider the wisdom of signing into law a Bill that has no workable funding mechanism while disregarding solutions proposed by private health funders, leading organisations, businesses and other key constituents,” Comrie says.

“We anticipate considerable resistance to the NHI Bill on Constitutional grounds, and as the HFA, we will continue to advocate for a more achievable approach to fulfilling universal health coverage aims.

“The timing of the recent flurry of activity in moving the Bill through the necessary hoops ahead of next year’s election invites the notion of a blunt instrument, an unrealistic election promise rather than a pragmatic solution for the highly complex health challenges South Africa faces,” he says.

Health Funders Association members, including leading lights in the industry such as Bankmed, CAMAF Medical Scheme, Discovery Health Medical Scheme, Fedhealth, Glencore Medical Scheme, Momentum Medical Scheme, Profmed and PPS Healthcare Administrators, to mention but a few, are ready to work with government to develop evidence-based solutions that will help secure access to quality healthcare for all South Africans.

“There is so much opportunity to make the NHI work. Private public partnerships and collaboration have achieved so much good for the benefit of South Africans in other sectors, and there is much our industry can contribute to help make quality healthcare more accessible and sustainable for all,” Comrie concludes.

Categories : Expert Opinion Healthcare Politics and RegulationsTags :

Op:Ed – How Collaboration can Help South Africa to Build a Better Healthcare System

On By ModernMedia
Photo by Sora Shimazaki: https://www.pexels.com/photo/diverse-anonymous-colleagues-shaking-hands-at-table-with-coffee-and-folders-5673475/

As various players in South Africa’s health arena give input into the National Health Insurance, and the form it should take, they are agreed on one thing: its goal to achieve quality universal healthcare for all South Africans.

The recent COVID-19 vaccine rollout is a good foretaste of what is possible for South Africa’s healthcare system through the power of cross-sectoral collaboration – and a great case study for health systems strengthening in other countries too.

The rollout saw the public and private sectors, trade unions and community organisations pooling their resources and expertise to get the vaccines to South Africans as fast as possible, and the campaign showed that the country has the resources and expertise to provide a better, more equitable healthcare service.

The question is how we take these lessons and embed them in a healthcare system that serves all of a country’s citizens, and does so in a sustainable way, while adhering to best practice standards.

The clear answer is through the power of partnership – which has been demonstrated to work both here and in the rest of the developing world. Promoting public-private partnerships (PPPs), can accelerate access and distribution of innovative medications. By working together, government, originator companies, and funders can ensure that patients benefit from the latest advancements in healthcare.

Rwanda, for instance, has made significant progress in managing non-communicable diseases (NCDs) through community-based health insurance schemes. Brazil has successfully implemented a comprehensive primary healthcare approach. These countries have prioritised prevention, early detection, and treatment of NCDs, which can be adapted to the South African context.

Locally implemented initiatives under the global Making More Health (MMH) programme include training community health workers to provide primary care services, supporting local entrepreneurs in developing innovative healthcare solutions, and partnering with NGOs to improve access to healthcare in rural areas. These initiatives have helped address complex healthcare issues by empowering local communities and leveraging local resources.

MMH is a social initiative from Boehringer Ingelheim in collaboration with Ashoka, which combines business and social values to unleash innovation and achieve economic and social progress in healthcare. The objective of this long-term initiative is to source social innovation around the world, to explore unconventional partnerships and business models, and to encourage Boehringer Ingelheim employees.

We must also turn our attention to NCDs, which are a major health threat. The WHO estimates that globally, they are responsible for 74% of all deaths. Research into South Africa’s NCD states can play a crucial role in health systems strengthening by identifying the most prevalent diseases, understanding their risk factors, and informing evidence-based policies and interventions. This would help target resources more effectively and improve health outcomes.

This requires robust health data, hosted on a digital infrastructure, which would promote data-sharing among healthcare providers, and encourage the use of standardised data collection methods. This would help create a more accurate picture of the population’s health needs and enable better decision-making across the entire health ecosystem.

We also need to make sure we retain our world-class doctors, and address our critical nursing shortage – it’s estimated we need about 26 000 additional nurses to fill the gap. Without sufficient personnel to deliver healthcare, all the best intentions in the world will not deliver universal health coverage.

We must invest in improving the working conditions and incentives for healthcare professionals in the public sector, strengthen primary healthcare services, and promote collaboration between public and private providers. This would help to ensure that the expertise and experience of these professionals is effectively employed to benefit the broader population.

Moreover, increased collaboration with innovator companies in the private sector, many of whom are already involved in initiatives to strengthen the health system, would ensure patients receive the right treatment while expanding reach across the entire population. This would help tackle inefficiencies, streamline processes, and enable better resource allocation.

The fundamentals of health system strengthening in South Africa include adequate financing, a well-trained and motivated healthcare workforce, efficient supply chain management, and strong governance and leadership. Addressing these gaps – through partnership and collaboration – would help build a more resilient and responsive healthcare system and ensure that South African citizens have access to better healthcare.

Categories : Expert Opinion Healthcare Politics and RegulationsTags :

Frank Dialogue on NHI: Medical Schemes are a Government Asset

On By ModernMedia

As the National Health Insurance (NHI) Bill makes its way through the approval process in the National Council of Provinces (NCOP), many actors in various sectors have called on the South African government to carefully consider the concerns raised regarding the proposed bill.

Stressing this point as one of the panellists in the Kwa-Zulu Natal leg of the Frank Dialogue on NHI hosted by media anchor and Leadership magazine editor, Prof JJ Tabane, and his team, recently in Umhlanga, Dr Katlego Mothudi, Board of Healthcare Funders (BHF) MD, acknowledged that both the public and the private sectors were not perfect, but cited that destroying the private sector was not going to accelerate the attainment of the global agenda of Universal Health Coverage. Strengthening a health system requires reform of six pillars; and the National Health Insurance formed part of the finance pillar only. He further noted that the private sector was a national asset to contribute to the success of health reform.

Other participants in the dialogue were the Minister of Health, Dr Joe Phaahla, Dr Kgosi Letlape (former Health Professions Council of SA and SA Medical Association chair), Zwelinzima Vavi (SA Federation of Trade Unions chair), Dr Nicholas Crisp (Department of Health Deputy-Director: NHI), and Nozibele Tshobeni (Sizwe Hosmed Acting PO).

The primary aim of these events has been to facilitate a constructive and inclusive discourse among various professionals in the sector, with the Minister of Health, regarding the proposed NHI Bill. 

Emphasising the importance of overcoming several issues before the Bill could be successfully rolled out, Prof Tabane acknowledged that the health crisis in South Africa was of significant concern, rendering the implementation of universal health coverage (UHC) a necessity.

Asked about the future role of medical schemes under NHI, Crisp reiterated that NHI was not about scrapping medical aids, but about the right of all South Africans to access affordable healthcare: “The bill does not abolish or repeal the National Health Act. It merely goes about a different way of financing – a single fund to care for the majority of the health benefits that we need as a nation to strive.

However, Dr Mothudi disagreed with Crisp and highlighting that a multi-payer system was a better model given the south African context that has load of fraud and corruption.  “Why not a multi-payer system, as originally proposed in the first NHI Green Paper?” he asked.

“Between now and that point,” Crisp explained, “we need the medical schemes to continue what they are doing but to do it more effectively than they are doing at present. They criticised us in the Health Market Inquiry, saying we did not provide leadership. Now we are providing leadership – we want to have a multilateral negotiating forum, we want to set prices, want to introduce other related measures:

A moot point made by Sizwe Hosmed’s Ms Tshobeni in her concluding remarks was that while she agreed that NHI was “overall, a good idea”, pushing the Bill through was putting the cart before the horse: “How we are going about it is really the problem.

“We are not that far apart in our discussions on this, but where we are drifting apart can be answered by the question ‘why are we here?’” asked Dr Mothudi.

“Going on blaming apartheid etc is not good. The Medical Schemes Act, for example, was promulgated in 1998 – post-apartheid. So, we must take responsibility for these challenges. Secondly, Government must provide stewardship, being responsible for the lives and healthcare of every citizen. Right now, we only have one Department of Health, not one for the public and one for the private sector.”

Also noted was that the private sector “does not run itself”. The National Health Act is there to guide practitioners and establishments how they should behave, while the Medical Schemes Act is enforced by the Council for Medical Schemes under stewardship of Department of Health.

While many views were expressed about the pros and cons of NHI, among the most common once again were, as already mentioned, the wisdom of a single payer system. Contributing his views on this, the BHF’s Dr Mothudi revived the originally drafted concept of a multipayer system for the fund: “A multipayer system was proposed in the first NHI Green Paper but was thrown out! A multipayer system would work in the same way as it did during the COVID vaccination campaign. When standing in the vaccination queue you wouldn’t know who was paying for the service for the person in front of you – employer, medical aid, or government?

“The pricing and service for the vaccine and procedure,” he said, “was set the same for all and for everyone.”

To watch the Frank Dialogue Click Here

Categories : Healthcare Politics and RegulationsTags :

AfriForum Report Exposes Dangers of National Health Insurance

On By ModernMedia

The National Health Insurance (NHI) will further widen the inequality gap, put even more pressure on the already overburdened taxpayer and lead to an outflow of medical expertise should it be implemented. AfriForum has detailed these and other consequences of the NHI in a new research report.

In its report, the organisation details, among other things, the ideological basis of the NHI, the place it occupies in the ANC’s National Democratic Revolution (NDR), the economic consequences of the centralisation of health financing and the vagueness in the bill itself. Furthermore, the report provides an overview of centralised health systems in a number of other countries and how they compare or contrast with the economic and policy environment in South Africa.

One of the biggest issues with the NHI Bill is its funding. According to the report, four possible sources of income are currently being investigated that will have a negative impact on taxpayers – including payroll tax. This option entails that the government will require employers to recover a portion of their employees’ salaries which will then be remitted to the government – this on top of the deductions that are already recovered from employees’ salaries. South Africa’s marginal income tax is already higher than that of most other countries such as Canada, the USA and Namibia. Although this is the same as Australia, Switzerland and South Korea’s marginal income tax, South Africa has little in terms of service delivery to show for it.

The research finds in almost all the areas of investigation that NHI will be harmful to the economy and negative for the well-being of most South Africans and concludes that the bill should be rejected by parliament and opposed by the health sector.

According to Louis Boshoff, Campaign Officer at AfriForum, this report appears at a critical time where the parliamentary battle over the NHI Bill rages on and many misconceptions about it are circulating. “NHI is easily summarized incorrectly with slogans such as ‘free health care for all’, but the report takes a step back to obtain a more sober and objective picture, namely that the policy is expensive, unmotivated and unworkable,” says Boshoff.

The full report is available at www.jougesondheid.co.za, where the latest information on NHI is posted.