The Helen Suzman Foundation (HSF) has given notice that, in its submission on the NHI Bill (NHIB) released for comment in June, it has demanded that the bill should be withdrawn pending a radical revision of approach.

In a brief accompanying its submissions on the NHI and Medical Schemes Amendment (MSA) Bills, HSF Head of Research, Charles Simkins, pointed to the fact that in its response to the White Paper released back in December 2016, the Foundation had already alluded to the fact that given the managerial problems in the public health system, it would be counter-productive to impose the extensive task of creating new links with the National Health Insurance Fund – including contracts between all public health service providers and the Fund.

Elaborating, Simkins expressed particular alarm by the Office of Health Standards Compliance 2106/17 report in which it was shown that only seven out of 851 inspections found health establishments fully compliant with requirements, with a score of above 80%: “By contrast 532 establishments were assessed as non-compliant or critically non-compliant, with scores of below 50%. On this showing, most public health service providers would simply be ineligible to enter into contracts with the NHI Fund.

“We were also alarmed at the lack of information about costing and financing. Especially in a period of low growth, such as South Africa is experiencing at the moment, there are many claims on additional tax rand.

“Neither concerns,” he added, “has been allayed by the publication of the NHIB.”

Taking this further Simkins said the minister’s failure to provide any estimates of the costs of NHI. This had now been left in the hands of a Benefits Advisory Committee and a Health Benefits Pricing Committee to decide, “leaving ordinary South Africans clueless about what services they can expect from national health insurance and what they can expect to pay for them not at the point of service, but by way of increased taxation or dedicated NHI contributions”.

“It follows that the implications for medical schemes are also unknown, since the Bills specify that medical schemes will not be able to cover services provided by the NHI,” he went on to note, making the point that since not all services will be covered by the NHI, there will continue to be a two tier system: one part covered the NHI, the other by medical aids or out of pocket expenses.

“The implicit assumption in the NHIB is that the two tiers will be distinct. But this is not the way in which users of the public health system operate at present,” the HSF researcher explained. “They may use the public system when effective treatment is on offer, but the available evidence indicates that many resort to the private system when it is not. Equally, under NHI, a user may well be happy to use an NHI contracted pharmacist, but may prefer a private consultation with a GP or specialist.

“Whether the private consultation will be possible for a service provided by the NHI is itself not clear, since a crucial section of the NHIB is ambiguous. In general, the NHIB makes no provision for people who shuttle between systems. It simply does not consider the possibility.

“Accordingly,” Simkins wrote, concluding the point, “we believe the NHIB should be withdrawn, pending a radical revision of approach.”

*The submission can be found here.