David Jackson: Business Day

THE National Health Insurance (NHI) is part of a detailed 10-point plan adopted by the government to address healthcare in SA. Medscheme CEO Andre Meyer said that a major aspect of the plan was revitalising public healthcare facilities that the Minister of Health has said was a prerequisite for a successful NHI system. He said it was crucial to place the NHI green paper in a proper context. He said the inequitable allocation of healthcare resources in SA was unsustainable and the impact on most of the population - including the unacceptably high infant and maternity mortality rates - must be addressed. However while he believes that the Minister of Health's vision for an NHI system is achievable, Meyer said that the 14-year time frame might prove to be optimistic. He said the scale of the overhaul of the public healthcare sector, the critical shortage of healthcare skills in the country, the socio-economic outlook and the degree to which SA's relatively small tax base would need to be expanded, must be taken into account. It is here that Meyer believes private healthcare companies can make a real difference. He said that companies active in the private healthcare sector should support the government's transformation initiatives by directing their socio-economic development and enterprise development budgets towards projects aimed at revitalising public healthcare facilities, or address the shortage of healthcare personnel such as the R1,24bn human resources strategy announced by the Minister. Meyer said that the Minister had stressed repeatedly that dismantling the private healthcare system was not on the agenda. He said there was a role for private medical schemes in an NHI environment and was encouraged that the discussion document implied openness on the part of the government to a multipayer model that could include medical schemes in the funding model. Meyer said there was potential for some South Africans being forced to abandon private medical schemes simply because they could not afford to support the contributions to a private medical scheme as well as the NHI. Medical schemes, he said, would certainly need to rethink their benefit structures and it was likely that medical schemes would offer less expensive top-up products to supplement the healthcare package offered by the NHI, as had happened in the UK. Meyer said while there was much in the green paper to be positive about there was still a lack of clarity around fundamental issues, however, if the NHI was successful in achieving its objectives, SA would be a much better place to live.

Aglaak Mahmood, CEO of Pro Sano Medical Scheme, said that the current situation where most South Africans were barred access to quality healthcare due to inhibitive cost was contrary to the Constitution's enshrinement of healthcare as a basic right. He said the private healthcare sector had not managed to increase cover to most South Africans significantly and that market forces, especially in the public sector, had been unable to increase access, reduce costs and provide greater satisfaction to most citizens. Therefore there was a need to review the health system drastically. Mahmood said he was also heartened by Health Minister Aaron Motsoaledi's statement that the public health sector did not see itself at war against private healthcare providers. This was important, as the private healthcare system had received a significant amount of criticism for levying costs that many considered to be detrimental to the industry's long-term sustainability. However, he said Minister Motsoaledi's statement cemented the view that both sectors were, in fact, on the same side, as, after all, the goals were essentially the same: to ensure the health and wellbeing of South Africans. Mahmood said he believed there would be little change in the medical scheme industry besides possible partnerships and amalgamations of medical schemes while the structure of NHI was being finalised and gained traction. But, he said, it was critical that private healthcare funders should be preparing for the anticipated impact of NHI, although certain aspects had not been outlined explicitly. He said that as soon as the structure of NHI was finalised it would be time for medical schemes to take an honest and candid look at their offerings. Mahmood said it was quite likely that members of the public in the lower-income brackets would choose not to supplement their medical care by contributing to medical schemes, but on the other hand, it was also possible that the NHI would not be able to provide beyond basic healthcare needs. In this case, he said, medical schemes might benefit if they were able to come up with innovative products - particularly if these met needs that were not addressed through the NHI.