On Thursday, 24 May, Cabinet approved the Medical Schemes Amendment Bill for publication in the government gazette.
Communications Minister Nomvula Mokonyane told the media that the Bill aimed to align the National Health Insurance (NHI) White Paper and the draft NHI Fund Bill. It includes new rules on benefits, prices and governance. Crucially, the amendments will enforce uniform tariffs for services and prohibit co-payments.
The State Liability Amendment Bill, providing for the settlement structure of claims against the state that result from the wrongful medical treatment of persons by servants of the state, was also approved.
Bronwyn Nortje commented in Business Day – 24 May 2018: “The announcement by Health Minister Aaron Motsoaledi that a major shakeup of the medical scheme industry is on the cards raises more questions than answers.
“I can’t help but wonder why there was such a rush to announce these changes before the publication of the Competition Commission’s Health Market Inquiry provisional report at the end of May,” wrote Nortje.
“Surely after so many years and so much effort from everyone in the industry, he could at least have pretended to evaluate and interrogate the recommendations before proposing new legislation. After all, it was Motsoaledi who instigated the inquiry to
investigate then rising cost of private healthcare in SA, specifically internal dynamics that may limit or restrict access to private healthcare.
“The Minister has undoubtedly had considerable pressure placed on him by the powers that be to lead the charge for a utopian dream of universal access to high-quality healthcare in the form of the NHI, but this just isn’t possible in the medium-term fiscal framework, or possibly, ever. If the Minister is serious about improving healthcare, in both the public and private sectors, he should be looking at health outcomes and not how many are serviced.
“Inefficiency and over-servicing might be the root of the problem and not medical costs. If this is the case, what is needed is an outcomes-based reimbursement structure that pays providers based on the quality of their outcomes. If doctors were evaluated more on clinical outcomes, they would be more inclined to think carefully before running expensive diagnostics.
“Until a start has been made to evaluate the public and private healthcare sectors on their outcomes rather than their inputs, a solution will not be found.”
Funding issue still the biggest stumbling block
The successful implementation of the National Health Insurance (NHI) programme hinges on its funding model, according to a legal expert Ian Jacobsberg, partner at law firm Hogan Lovells. (Fin24, 22 May 2018)
Even the Minister himself acknowledges there is a disparity between available funds and the funds necessary to achieve objectives and to get NHI fully operational, Jacobsberg said.
Currently, government subsidises employees’ medical aid through state-owned medical schemes, as a private sector employer would for its employees.
Jacobsberg said that is probably the starting point before they look at private sector medical aids.
The implementation will certainly depend on the usual problems – political will, financial resources and the correct use of financial resources and the priorities in the national budget.
Last year the Davis Tax Committee warned in a report that even though government expects NHI to cost R256-bn, this figure is set at 2010 prices. By 2025, there could be a funding shortfall of R72-bn, assumed at an average growth rate of 3.5%.