PROCESSES AROUND NHI
In our previous commentary, Qualicare expressed the view that we fully support the concept of Universal Health Coverage (UHC). CPC pointed out that much of what the NHI Bill envisages and aspires to is already in place via the State Hospitals, (Quaternary, tertiary, regional, divisional and local) as well as the multitude of state run Clinics, Day Hospitals and Pharmacies.
Since the release of the bill, the parliamentary process has commenced in earnest, and the deadline for public comment has just been extended to 29 November 2019.
Qualicare firmly aligns with groupings which stress the essential components that both the state and the private sector will be able to offer to a new National Health dispensation but cautions against fixed, untested and preconceived ideas about central financing, single source procurement, price fixing and purchasing by the state. These stem from a deep mistrust of the successful but currently poorly regulated, overpriced for profit private medical sector.
Central purchasing has been shown worldwide to be flawed and open to corruption and inefficiencies.
The recent report from the Health Market Inquiry has raised significant doubts about the probity certain sectors of the profession. There is no doubt in our minds that the private sector should be better regulated by reformed and better coordinated regulations, with special reference to:
- Setting of Maximum Tariffs (which up to now were frowned upon by the CC (Competitions Commission),
- The appointment of a supply side regulator
- The removal of Regulation 8, which has permitted exorbitant pricing for PMB related conditions by certain specialists and hospitals,
- Relaxation of the need for a full hospital package for every PMB and its replacement with a LIMS (Low Income Medical Scheme) type product and compulsory membership of such a LIMS product by the 6 million employed but uninsured persons.
- An intelligent review of the work done on the Risk Equalisation Fund so as to bring this concept into urgent existence to compensate for the anti-selection against private schemes, based on the laudable principles of Social Solidarity.
- Compulsory membership of those employed in the formal sector
- Urgent review of the regulation which demands a 25% cash reserve for each medical aids, irrespective of the rand value of this percentage.
- Urgent revision of the restrictive practices listed in many of the HPCSA Ethical Booklets, of to bring them into line with the 20th Century thinking.
- Realistic analysis of the country’s ability to afford and pay for NHI as envisaged by the new bill.
If we are able to do the above, then RSA could move rapidly along the road to UHC with the medical aid sector expanding to 16 million of the 50 million South Africans, leaving the state with a far less onerous and less expensive job, namely to care for 24 million+ unemployed and uninsured persons.
All agree that a slow, phased in change is the way to go. However, given the timelines of contracting between 2022 to 2026, it suggests that there may well be some form of “big bang” kick-off to the process with selective contracting of Family Practitioners forming the vanguard of NHI in the form of allocation of capitated patients, in return for quality assured practice facilities of a multidisciplinary nature.
It is with this in mind that I have again attached the self-accreditation forms for you to inspect your own practice, and send the completed form to [email protected]. We will keep these self-accreditation forms on file and submit them to government at an opportune time. Act now, Self-Accredit your practice and send the document to Emma, as well as send us your urgent comments.
Our country already has an extraordinarily small yet meaningful tax paying base, estimated at between 4 and 5 million persons who will bear the lion’s share of the taxes imposed to finance the NHI, over and above losing out on tax credits against medical aid subscriptions. This has disturbed Business Unity South Africa who are already in talks with Government as well as within the Nedlac Forum.
It is rumoured that many overseas investors have sold their stakes in SA Healthcare as well as SA stock in general, expressing their doubts about the viability of the processes and making it more and more difficult for Government to raise capital in the finance markets.
So remember that you have until 29 November 2019 to offer comment on the NHI Bill.
Please send your comments and your self accreditations to CPC/Qualicare, email address; [email protected] where we will be compiling a document to submit to Government on your behalf.
Questions remain as to the future of the medical scheme industry and the quality of care you previously enjoyed and expected as a result over the years.
Tony Behrman and QC team