Let’s kick off with a question posed by Elsabe Klinck on Twitter: “(NHI) Bill proposes that Competition Act be amended to exclude all activities of the NHI Fund from the Act… not only would this allow collective negotiation, it would also allow collusive tendering? Or am I missing something?” Interesting to see what the answer turns out to be.
Then, Katharine Child has written a piece in which the Schemes Bill is characterised as ‘absurd’ in its intention to limit middle-class access to private healthcare by Alex van den Heever – see the following extract: “Health Minister Aaron Motsoaledi has promised that medical aids will continue to exist alongside National Health Insurance (NHI) – but the very bills he has proposed seem to say the opposite. In fact, according to experts, the bills – in their current forms – say that medical aids can only cover what NHI doesn’t. In effect, this means that if the NHI fund covered a caesarean section, medical aids wouldn’t be allowed to pay for the procedure, a move that would drastically change how the middle class access healthcare. It is a contradiction that, experts told Times Select, could very well see the Health Department facing lawsuits. A professor at the Wits School of Governance, Alex van den Heever, said both the NHI and Medical Schemes Amendment bills tried to restrict what medical aids could offer, reducing the access of middle class to health. “If the government wants to take away a right to healthcare they need to do so with a rational purpose. Rationality is a constitutional principle. Restricting access to private healthcare has no rational reason,” he said. Van den Heever added that this attempt to “prohibit medical schemes from covering benefits covered by the NHI Fund” was absurd. “This is an absurd infringement of the right to healthcare as it would force everyone to use a public health system which cannot be held to account for performance. I do not see this provision ever seeing the light of day as no health system in the world takes away the right of people to select their own care with their own money,” he said, repeating that there was “no rational public purpose” served by the provision.” The full article is here.
Section27 notes: “Section27 supports the extension of healthcare to as many South Africans as possible, but until the public health system is fixed and private healthcare better regulated, this will remain a chimera. On 21 June 2018, Health Minister Aaron Motsoaledi released the National Health Insurance and Medical Schemes Amendment Bills. In doing so the government’s aim is to create a single framework for the provision and purchasing of healthcare services, to consolidate health revenue and to realise the right of everyone to access to healthcare services. SECTION27 works to ensure the realisation of the right of access to healthcare services. We therefore support wholeheartedly any efforts to achieve universal health coverage. We have, since 2009, been supportive of the development of National Health Insurance (NHI) and of Motsoaledi’s efforts to move South Africa towards an equitable healthcare system. Regrettably, we believe the Bills fail to provide a realistic path to universal health coverage.” The full article is here.
Tom Eaton in TimesLive is particularly harshly against the NHI writing that not only will it send doctors running away but will also slowly at first but certainly destroy healthcare in SA – an extract from his piece: “When Aaron Motsoaledi told us in April that healthcare in South Africa was not collapsing, he was telling the truth. In many parts of South Africa healthcare is not collapsing. Because it has already finished collapsing. It’s done. It’s over. Any set-up where you wait for a year for radiation therapy, as is the case in some hospitals in KwaZulu–Natal, is not a system. It is a ruin.” The full article is here.
There is also some support for the NHI though: an FFC official says in Business Day that the healthcare challenge is structural and not clinical.
There are various discussions on the Medical Schemes Amendment and the National Health Insurance Bills here.