Only a blended South African healthcare system will serve diverse patient needs in a viable NHI
Kevin Aron, Principal Officer of Medshield Medical Scheme
20 July 2023
Johannesburg - South Africa's healthcare system has experienced significant transformations over the years. One of the most pressing issues is the need for more resources and funding, which has resulted in limited access to healthcare services for South Africans. The government has, to some extent, attempted to include private healthcare providers in the planning phases to tackle these concerns and enhance access to quality healthcare services. Implementing a national health insurance (NHI) scheme is a pressing issue. While the NHI could provide universal access to healthcare for all South Africans, it is critical to address several shortcomings to ensure its success.
Are South Africans desperate for NHI?
Typically, the answer would be yes. While private healthcare providers in South Africa play a significant role in the healthcare system – providing primary care, specialist care, and hospitalisation, they cannot serve the entire population. Private healthcare is generally more expensive, and many South Africans need medical aid cover to afford it. But statistics show that only 16.1% of South Africans are covered by a medical scheme due to perceived high premiums. The reason for high premiums is partly influenced by the fact that medical schemes are required to provide members with prescribed minimum benefits (PMBs) that cover at least 271 conditions and 26 chronic diseases.
This requirement to cover PMBs at cost is the most critical driver of medical scheme contributions. Furthermore, schemes frequently have little control over the fees charged by specialists since some specialists charge up to 700% of the medical scheme rate, which could effectively drain the scheme. As such, medical schemes must charge premiums to ensure their members will be adequately covered in the long run.
Because of this affordability problem, the majority of patients, therefore, still rely on public healthcare, which is either free or low-cost. It appears beneficial, but the public healthcare system is overwhelmed by an exceedingly high number of patients and minimal resources. For instance, the healthcare facilities available in southern Gauteng for severely ill patients with internal medicine diseases are under immense strain. Central and regional hospitals in this region have frequently had to cease admissions due to bed occupancies surpassing 100%. This issue first emerged in 2013 and has progressively worsened over time.
On the other hand, private healthcare providers possess more significant resources and are compensated for their services through medical scheme claims – enabling them to invest in state-of-the-art technology and equipment, hire highly skilled medical professionals, and offer a more personalised and comfortable healthcare experience. It can be particularly significant for patients needing complex or long-term care. However, these advantages come at a cost. South Africa is known to have some of the world's most expensive medical aid. According to the World Health Organisation, South Africa allocates a larger share of its total health expenditure (42%) to voluntary private health insurance than any other country, benefiting only 16% of the population. Sadly, most South Africans lack medical aid coverage, leading them to seek care from inundated and overburdened state hospitals.
Medshield would propose a "mixed system" where private and public healthcare co-exists equally. It would be a system that allows patients access to quality healthcare from a state provider or a fixed fee service from private providers regardless of income level. This approach aligns with the National Health Insurance (NHI) concept, which is based on the principles of social solidarity and the belief that healthcare is a fundamental human right. The NHI aims to offer comprehensive healthcare services to all citizens, irrespective of their financial capabilities. The government plans to fund the NHI through taxes and mandatory contributions from all citizens. These funds are then used to deliver affordable and easily accessible quality healthcare services to everyone.
How will the government regulate a "mixed system"?
Various bodies regulate the healthcare industry, including the Council for Medical Schemes and the Health Professions Council of South Africa. While implementing the NHI is commendable, the execution in South Africa will likely encounter significant challenges. Here are a few suggested solutions to some of the potential difficulties:
- Corruption and mismanagement of funds – Implementing robust measures to prevent corruption and ensure accountability is crucial. It may include strengthening the regulatory framework, enhancing transparency and accountability, and providing training and support to healthcare workers. Effective oversight of the NHI is essential to prevent misuse of funds.
- Limited resources and capacity – The current public healthcare system in South Africa is under-resourced and strained. The government should invest in recruiting and training more healthcare workers, constructing new healthcare facilities, and upgrading existing ones. It will ensure fair compensation for healthcare professionals to prevent a brain drain to the private sector.
- Quality control – While the NHI has the potential to provide universal access to healthcare, it is vital to ensure that the healthcare services offered must be of high quality. Developing and implementing quality control measures appropriate for South Africa is necessary to establish standards for healthcare facilities and workers. Training and adequate support must ensure that public and private service providers meet these standards consistently. Monitoring the quality of healthcare services and taking appropriate action when standards are unmet is also crucial.
- Equitable access for all - Healthcare services must be provided based on a patient's need rather than the ability to pay. Policies and programmes should be developed and implemented to promote fairness in healthcare, such as ensuring that healthcare services are available in underserved areas and providing financial assistance to those who require it.
Nonetheless, as Medshield Medical Scheme, we approach the approval of the NHI Bill by the National Assembly with caution. Regrettably, the revised version of the bill did not incorporate many valuable contributions from multiple stakeholders. Despite this, we remain committed to supporting the implementation of the NHI to increase access to quality healthcare for all South Africans. Strong partnerships, collaborative efforts, public healthcare reforms and private healthcare involvement can lead to a viable and effective NHI.
FIN
(986 words)
Thought leadership article by Medshield Principal Officer, Kevin Aron
DOCX - 384 Kb
