Minister of Health, Dr Zweli Mkhize

Within 24 hours of the National Health Insurance (NHI) Bill being presented by Health Minister, Dr Zweli Mkhize, to parliament and later to the media last week Thursday, several sector leaders attending the SA Medical Association (SAMA) Conference in Durban on Friday were given the opportunity to express their views on what was presented in parliament.

In this exclusive Med Brief Africa report, brief responses and comments are given in answer to “what did you like about the Bill and what concerns you most”….

Dr Angelique Coetzee, Chair, SA Medical Association

What I like most about the NHI Bill is that it will make funding available for primary health care thereby providing universal healthcare to all. Universal healthcare needs to be primary healthcare orientated and needs to have patient outcomes. From recent meetings we have had with the Department of Health, we are on the same page with this.

One of my main concerns is provider remuneration, the proposed capitation model in particular. What we don’t know currently is the extent of the primary healthcare burden in our communities, and this worries me.

Another concern is the time deadline: I don’t think full implementation of NHI by 2026 is feasible.

The potential for corruption is also a worry. If we don’t get corruption out, if there is not a genuine will and if we do not keep government responsible and accountable, NHI might not have impact we need it to have.

Where medical schemes are concerned, they will have to look at their benefit designs to stay relevant. At the moment they are more specialist and hospital driven. They should be more primary health orientated.

While the NHI Bill is being implemented, I believe it will be business as usual for the schemes. They won’t be touched. I think things will only start happening once NHI is fully implemented.

Prof Morgan Chetty, IPAF/Health Federation of SA

What I am pleased about is that we now have a minister who apprediates the participation of providers and stakeholder. I think what is clear is that government won’t be running the NHI project on its own.

On the bill itself announced, I don’t think much changed from what we already knew. What does appear to have changed, however, is the way it is going to be implemented. What we will need now is collaboration, more input from the public and a lot of dialogue!

What concerns me is the one-liner coming out of it that “all the medical aids will have to go” but they don’t say how. When the man in the street sees that, there is going to be panic. All the good the bill brings could be damaged by this.

Dr Kgosi Letlape, Chair, Health Professions Council of SA (HPCSA)

What I like about the NHI Bill is that we are going to do it! Even the NHS in the UK is still being worked on. It never had to be perfect to be launched. There has to be a willingness to meet the need that’s brought about NHI and we’re going to get on with it. There will be lifetime improvements from this.

What concerns me is the fact that there is still hesitancy about dealing with the two sides of the business of our healthcare. There isn’t any forceful direction to say “Public:  medical aids are a thing of the past, this is merging the two”.

Funding of NHI is the medical aid system. There will be no co-existence. And this hedging about what we cover and what is outside, we need in the public domain to get rid of this hesitancy. This is it! This is our system!

Dr Mvuyisi Mzukwa, Vice-Chair, SA Medical Association

What I like about the NHI concept is that it is going to improve our economic interests in health. Definitely a step in the right direction. If you look at Japan’s healthcare story, for example, they started poor just after the Second World War. Admittedly they have had to make some adjustments along the way, but they now have a fully-fledged universal system. So I think we need to start as soon as we can.

My real concern about NHI and its implementation is the political instability in our country and in particular within the governing party. They are implementing the policies and if they are unstable themselves, I worry about that.

But that said, I am still confident about the progress being made in healthcare.

Dr Katlego Mothudi, MD, Board of Healthcare Funders

The NHI Bill finally being presented in Parliament yesterday confirms that we now finally have focus! Putting this into context, when one tracks the policy reforms, they all started pre-democracy. But there has been an acceleration in last two years.

What I have liked about it has been more willingness of the state to engage with non-state entities. Previously there was a feeling of antagonism between entities, but we saw yesterday a large majority of non-state actors supporting concept.

My concerns are not about the bill itself, but governance, accountability etc. It will need organisation which reduces fragmentation and increases accountability. Leadership and governance will be very important.

The future of medical schemes? The medical scheme environment was always going to change, NHI or no NHI. Three determinants of this will be the Health Market Inquiry (HMI) recommendations, the Medical Schemes Amendment (MSA) bill, and the Conduct of Financial Institutions (COFI) Bill.

Under NHI, there won’t be the same number of schemes. However, there will still be people not covered by NHI, such as foreign nationals and refugees. Secondly, not all benefits will be included under NHI and there will be services falling outside. So alternative cover will always be necessary.