The National Health Insurance (NHI) scheme is a buzzword among SA health-care players - yet all that is known about the proposed programme is that it will be some time before it is implemented.
What is clear is the pronounced need for such a system. With the public sector bearing the burden of disease and tasked with overseeing the health-care needs of more than 40m people (with a budget of R70bn), its responsibilities are onerous, to say the least.
Government has identified the NHI as the best vehicle to lighten the sector's load - but predictions are that implementation will be a long-term process.
Heidi Kruger of the Board of Healthcare Funders (BHF) says that the various aspects relating to the implementation of the new system would have to happen in tandem. For instance, the improvement of the conditions and resources in the public sector would need to happen at the same time as other changes are introduced, such as encouraging more uniformity in the pricing of health-care services. She says that these interventions may be introduced from next year, with an overarching legislation expected to be in place from April 2010.
Meanwhile, though the scheme's provisions have yet to be finalised, Kruger says that what is known is that it will provide a comprehensive benefits package. Also, upgraded public-sector facilities will form the backbone of health-care provision. In addition, the work force will be expected to contribute a premium of 3%-5% of their salaries to an NHI Fund; a single purchaser will be established to negotiate and set industry tariffs; and, as in the UK, private-sector practitioners will be able to gain accreditation as NHI providers. This model is based on similar principles to the systems of Belgium, France and The Netherlands.
How has the private sector responded to the proposed introduction of NHI? "Fundamentally, they're in favour of universal access. However, they're also in favour of a phased-in approach of high-quality health care," says Kruger.
But the players themselves voice some concerns. For Anton Rijnen, CEO of Medihelp, question marks surround the universal coverage mooted by government which, he maintains, requires far greater resources than are available. "Then again, if the intention is to follow a model with less benefits than we expect, and where access to these benefits is streamlined through well co-ordinated levels of care, we probably could accommodate a universal health-care system. The proviso is that the private sector should be involved from the outset."
Regarding the scheme's effect on the private sector, Rijnen says that "the only working solution is a partnership between the public and private sectors. Government has said that the private sector is not under real threat, which is positive". He further applauds government's realisation that NHI is a long-term project, and that quick fixes will not achieve the required results.
Metropolitan Health Group's Blum Khan says that the successful implementation of the scheme relies on swiftly identifying improvement targets for the public, and taking prompt action - steps that should be taken regardless of whether or not NHI is introduced. Addressing the skills shortage is key in this regard, and Khan's suggestion here is to reform the licensing of service providers in order to provide a conducive environment where licensing is a simple and accessible process. "We can certainly benefit from the learnings of international schemes," he says.
Khan says that the introduction of NHI would lead to the consolidation of the open medical scheme market, and that requirements around capital adequacy may come under review. However, there would still be a role for private schemes to play, especially as some members may wish to purchase top-up cover - and this may prompt new competitors to enter the market.
Kruger shares the view that, if anything, the market will grow, as an additional 40m people will be seeking cover. "Opportunities for medical schemes certainly exist, though they may have to change the way they operate currently."
There may be certain drawbacks to the system: Khan frets that current uncertainties may prompt providers to seek opportunities beyond SA, worsening the skills shortage. Also, poor management of the scheme's implementation may lead to instability in the sector.
However, the advantages are undeniable: "The larger risk pool will give better visibility to the burden of disease, and there will be more opportunities to apply risk management techniques," Khan says. "We will also benefit from better purchasing leverage with providers and service suppliers, and the operational costs of NHI should be low."
But perhaps most compelling is Kruger's observation that access to health care is a moral issue. "Access to health care is a basic right enshrined in the constitution. It is for this reason that policymakers are proposing a system overhaul."
- Attempts to get comment from the department of health failed, it did not respond to requests for interviews, or e-mailed questions.
