Access to healthcare and the ideal of a national system of health insurance are important concepts.
Dr Larisse Prinsen, senior lecturer in the Department of Public Law at the University of the Free State (UFS) says as is often the case, an ideal may be fine in theory, but falls short when it must be put into practice.
On the National Health Insurance (NHI) Bill that was passed by the National Assembly in June, Prinsen says this bill is no exeption and many concernes and critiques have been lobbied at the bill.
The process to sign the bill into law by the president, may be many years away, but the process have now began.
“The bill aims to ensure that all South Africans have access to quality healthcare services and to provide for the establishment of a fund which will be utilised to pay for almost all medical treatments from accredited provides, with rates to be determined by the state. Private health insurers will thus only be able to pay for treatments, health products and services which are not covered by the fund.”
Prinsen says the bill has been contentious from the inception and has been fought against from the start.
There have also been multiple court cases launched against the Bill and various different voices have been raised against it.
She states some of the advantages as well as foreseen disadvantages fo this national health insurance as follows:
Advantages:
- Lower overall health-care costs by having the government determine and control the price of healthcare and by decreasing administrative costs;
- Finite determination of costs related to health-care procedures with no unexpected costs or depletion of medical aid benefits;
- Potential improvements in healthcare due to higher standards being set for hospitals and clinics;
- Possible improvement in available services, hygiene and safety in public hospitals;
- The removal of health-related barriers to education for children with undiagnosed or untreated health issues;
- Stimulation of the economy by allowing for a healthier workforce where the NHI provides for preventive care;
- Better salaries for medical practitioners in the public sector;
- Improvement of social security by for example, preventing future social issues such as crime and welfare dependency;
- The promotion of equality by removing barriers to health care based on the ability to pay; and
- A real attempt being made at the progressive realisation of socio-economic rights and an addressing of the inequities and scarcity of health-care resources in South Africa.
Disadvantages could include:
- A blow to autonomy as all South Africans will be forced to make use of NHI, regardless of whether they want to or not;
- The healthy paying for the sick and increased burdens on taxpayers;
- Uncertainty and vagueness surrounding the financial aspects of the NHI;
- A decrease in financial incentives to be and to remain healthy;
- Unemployment could rise as those previously employed by medical aid schemes may be retrenched due to whole departments of these enterprises becoming redundant;
- Medical practitioners will seek greener pastures and more financially lucrative employment overseas leaving South Africa with a human resource deficit in context of healthcare;
- Long waiting times for elective procedures as the primary focus of the NHI will be directed towards basic and emergency healthcare;
- There may be fewer healthcare facilities and providers due to an uncertain system of accreditation;
- A decrease in the quality of care provided;
- Uncertainty regarding what will in fact be covered by the NHI and what will not;
- The NHI may be seen to be political pandering rather than a real-life workable and practical system;
- NHI necessitates confidence by the people in a system under governmental control; and
- The (very real) potential for corruption and misappropriation of funds.
The NHI will have positive and negative outcomes.
“For South Africans without medical aid or in lower income groups, the NHI will be beneficial in that it will offer more equitable access to healthcare services and will allow for them to consult private healthcare practitioners and make use of private healthcare facilities and practices. Not only will it provide health insurance to those not currently a member of a medical aid, but the NHI purports to improve the resourcing of public hospitals and health-care services as the burden of care will be more evenly distributed.
“For South Africans who do have medical aid, the NHI may be a shock to the system. Those who are accustomed to private care may have to settle for lower standards while still paying a similar or higher fee. South Africans within a certain income bracket will still have to make mandatory monthly payments towards healthcare in addition to carrying a higher tax burden.”
She explaines that once the NHI is implemented, medical aid schemes will not be able to offer any services offered by the NHI and will only be able to provide for “complementary or top-up cover” which does not overlap with that which is provided for by the NHI.
“The bill does provide for gap cover, but the relevant section of the bill is greatly understood and interpreted as meaning that medical aid schemes will cease to operate since current members will be obligated to make use of their NHI.”
She said that the NHI cannot be avoided and could be beneficial for all. “To truly live up to its potential for betterment, it should not be rushed.”
