SpesNews Volume 127
The road to Universal Healthcare Coverage (UHC) has been given a significant push with the release of the NHI (National Health Insurance) White Paper in December last year (2015). The White Paper broadly outlines some key elements and in its entirety warrants meticulous inspection in order to correctly understand and interpret the myriad of comments that is sure to follow the release of this document. The implementation of a NHI will herald the dawn of one of the most dramatic changes in the landscape of South African Healthcare – both public and private.
The White Paper envisages a single NHI fund that will be used to purchase service from both the public as well as the private sector. The role of the current medical schemes will be restricted to the provision of top-up complementary services. An amendment to the Medical Schemes Act can thus be expected to redefine the scope of current services on offer from the medical schemes.
The 3 phase NHI project is scheduled to be implemented over a 14 Year period and a pilot of 10 sites have been launched. These pilot sites would also be used to test and refine the recruitment of General Practitioner participants, the implementation of school health programs, the referral pathways to a district clinical specialist as well as primary care outreach teams.
Within the NHI, the state will be purchasing services from both public and private sectors. Any service provider (facilities and specialists) will be subject to an accreditation process to be eligible for NHI reimbursement. There is also the possibility that the accreditation could depend on the submission of a valid Certificate of Need (CoN). While abandoned on a previous occasion, the CoN is present in the White Paper as one of the major areas that still remain contentious.
The White Paper also aims to rid the healthcare industry of medical aid brokers. The brokers are estimated to make in excess of R1,5 billion a year).
Some points the White Paper did not adequately addressed, hinges on one of the very limited resources within the South African healthcare environment – although a presumably global shortage of qualified healthcare specialists exists in every country, in South Africa the low number of specialists are even direr when compared to other developing economies. Without the buy-in from the specialists, the success of the NHI becomes more questionable. The current fee offered to General Practitioners also does not appear to meet the expectation some of the practitioners had in mind and specialists are probably not going to be enticed by it either.
Other important omission was an updated cost projection for the project, a clear indication of how it will be reimbursed and by whom. Current estimates in the White Paper have been estimated assuming an economic growth projection of about 3,5% per year (although a 1,5% per year would probably be closed to the actual). The effect any increase in tax or the implementation of additional taxes will have on the poor, would certainly have to be one of the major considerations going forward.
Additional areas not directly addressed relate to the workers and specialists. After many struggles, worker unions have managed to secure private healthcare for their members. The impact a centralised specialist facility would have on these workers could not be overestimated as these workers at present enjoy freedom of choice to some extent when requiring specialist management. The medical specialists are generally used to working long hours at a stretch and the reimbursement from the medical schemes have often been viewed as not fully reimbursing them for the time, effort, sacrifice, input and risk they are exposed to. Offering them any less, risks them leaving the professional altogether. The rapid decline in the number of specialists in Obstetrics attest clearly to this fact and could be seen as a precedent where medical specialists concluded that the risk and effort associated with the discipline outweighed any potential rewards.
South Africa is a very special country and any effort to alleviate the suffering of so many South Africans has to be lauded. We do need to focus on collaboration when considering solutions to challenges of this magnitude.
The White Paper has been released. The period for comments is now. SpesNet would highly recommend that the document be read and its profound meaning to so many be acknowledged. It is only then that the necessity to respond and comment on this paper will becomes compelling.
Interested specialists are invited to comment on the Draft benefit definitions for early and locally advanced breast cancer as well as for locally recurrent or metastatic breast cancer. The documents can be obtained from the
Council for Medical Schemes (CMS) by clicking on the links provided. In accordance to Circular 7 of 2016, feedback on these should reach the CMS by 5 February 2016.
In Circular 4 of 2016, stakeholders are also invited to comment on the results of the ITAP (Industry Technical Advisory Panel) measuring quality and outcomes of managed care interventions. The documents can be obtained from here.