The long road ahead
By Jonathan Faurie, 24 July 2017, fanews.co.za.
The NHI White Paper has been existence for a month, and we have all sat and debated what it means to us.
There is however some issues that needs to be addressed and possibly ironed out before they go ahead with it. Werksmans Attorneys held a special briefing earlier in July to discuss this from a legal perspective.
Relevance of the White Paper
We have heard and taken into account government’s position on the NHI in the past. However, this was communicated through media reports and briefings as well as a Green Paper on the subject, which was released in 2011.
Neil Kirby, Director at Werksmans Attorneys pointed out during the company’s special briefing that the White Paper is different as it holds a certain legal gravitas, the structures and positions spelt out in the White Paper is more than likely a true reflection of what the final NHI model will look like.
The NHI suggests certain procedures which are drastically different from current procedures we see in the industry. Kirby pointed out that these changed positions may cause legal headaches for government.
First is the triumvirate freedom of choice, association and movement. People have the right to choose to participate in something, to belong or associate itself with a company and to move from one company to another.
The NHI White Paper states that every citizen will be forced to contribute to the NHI. This basically contradicts all of the freedoms discussed above. “This could have major implications in the future. Government has said that medical schemes will offer complementary services and products within the NHI landscape. What if labour unions do not like this and take exception to the fact that their members will now not receive the products and services that they used to by their medical schemes?” asked Kirby.
Kirby added that in order for the NHI to work, government will basically be taking away the automatic right to belong to a medical scheme. “In order to do this, government has to change the Medical Schemes Act. This has to be passed through parliament and be discussed with the public through proper engagement forums,” said Kirby.
Hospitals will not be the same as they are now. The National Healthcare Act (the Act that will eventually govern the NHI) aims to streamline hospitals classifying them as primary healthcare facilities, secondary healthcare facilities, tertiary healthcare facilities or quaternary healthcare facilities. Primary healthcare facilities offer basic care and the level of care offered is escalated until we get to quaternary healthcare facilities.
This may be a simple task for government hospitals, but to classify a private hospital that offers all four levels of healthcare may become a complicated task.
The complication does not stop there. A person accessing these facilities may not just walk into any facility and request care. “Getting authorisation for a medical procedure at the moment is a fairly simple task. You call your medical scheme, get an authorisation code and go to a designated service provider to get the procedure done. Under the NHI, a person needing a knee replacement for instance must go through all the levels of care offered (as pointed out above), getting authorisation at each juncture before finding a facility that can offer the required care,” said Kirby.
People have the option to go straight to the specialist, provided they can pay for the specialist’s services out of pocket while contributing to the NHI and pay medical scheme premiums.
The problem statement that gave rise to the NHI in the first place is government’s rhetoric that healthcare is too expensive.
This is true, but who is to blame? “There is a general and overall perception from government circles that the private sector (medical schemes) is contributing to the excessive cost of healthcare,” pointed out Kirby.
This is where the problem comes in. Is the reliance on medical schemes not symptomatic of the greater problem of healthcare providers charging what they want for the services they provide? Medical tariffs are still nowhere to be seen, so to say that medical schemes are the be all and end all of the cost debate in the industry is very dangerous indeed.
Attention needs to be paid to the costs of accessing healthcare services in hospitals for people who don’t belong to a medical scheme. If that was resolved, would the reliance on medical schemes not be less? There were legal challenges and court battles with regards to medical tariffs, why has this not been resolved?