David Jackson: Business Day

A NATIONAL Health Insurance (NHI) system as outlined in the government's recent green paper could create opportunities for medical schemes. Mark Arnold, principal officer of Resolution Health Medical Scheme said the emphasis of the green paper was very much on primary healthcare, which was positive. He said that one of the major impediments to reducing costs in the private sector was that there was no room for schemes to fund preventative healthcare from medical scheme contributions, since the current regulatory framework focused on curative care. Preventative care would assist patients to avoid treatment in hospital, he said, as the introduction of prescribed minimum benefits (PMBs) had made the system even more curative care-based. Arnold said that if schemes could focus more on funding preventative care, healthcare costs in the private sector would drop significantly. Neels Barendrecht, chairman of Agility Global Health Solutions, said improvement of public sector healthcare delivery, which was at the centre of the reform, was commendable. He said this would not only allow access to quality care for the majority of citizens but would also assist in driving down the cost of tertiary care, as private healthcare providers would face far more competition. Barendrecht said that the burden of disease impact on the healthcare system was a major factor in escalating healthcare costs across both private and public healthcare systems. This could be addressed through socio-economic impacts, such as a focus on primary and preventative care. Although few details have been provided on how the NHI will be funded or what benefit package it will cover, one possible scenario is that the current medical scheme environment is likely to shift dramatically, possibly back to a more traditionally based insurance system. This would see consumers accessing most of their healthcare through the NHI but having the option of buying additional top-up cover to purchase an upgrade in services.