Private practitioners reject NHI

Minister of Health, Dr Aaron Motsoaledi. Picture: Thapelo Maphakela
Minister of Health, Dr Aaron Motsoaledi. Picture: Thapelo Maphakela

With the National Health Insurance (NHI) programme already in its pilot phase, and being hailed by government as another success, the SA Private Practitioners’ Forum has rejected the system in its current form, saying government should concentrate on using scarce taxpayers’ resources to pay medical premiums for the poor, rather than insure the entire nation.

Speaking on behalf of the 3 000 doctors affiliated to the forum, CEO Dr Chris Archer said last Wednesday: “Universal health coverage is not the issue, but the NHI version is a concern,” he said.

Archer explained that while the NHI was a grand idea, they believed it was “poorly conceived” as it seemed to be based on abolishing the two-tier system (public and private healthcare) rather than pioneering an affordable mechanism to improve access to quality healthcare for the poor.

The NHI is a finance system launched by government five years ago. The system is aimed at abolishing the two-tire health system and pooling together funds in an effort to provide quality healthcare services to all South Africans based on their needs and irrespective of their incomes.

Once fully implemented, the system will work in a similar way as medical schemes do. Patients will go to accredited doctors and hospitals without paying upfront, and the NHI fund will reimburse doctors and hospitals for the services they provide.

However, Jasson Urbach, director of the Free Market Foundation, said: “The state does not have to provide free healthcare for all. It should rather focus on those who [are in] need but cannot afford to pay for healthcare, and leave the rest of the population alone.”

Johann Serfontein, a member of the healthcare policy unit at the foundation, agreed. “Why is the approach to healthcare suddenly being addressed so radically differently from housing and education?

“One can similarly address this by supplying free healthcare to the poor and indigent, and letting those who can afford it look after themselves. At the moment, the poor already receive free healthcare at public institutions, barring a R20 admin fee.

“If this R20 admin fee is scrapped, it only leaves the missing middle class – the employed – which has to pay unaffordable full prices for public health, yet they cannot afford extensive private healthcare. These are the people who need to be assisted in some creative funding model,” he said.

The implementation of the first phase of the NHI is in full swing. The NHI white paper was released by Health Minister Aaron Motsoaledi (pictured) in December.

The paper was supposed to provide clarity on how the NHI would be financed and how much would be needed to run this ambitious plan, but little was mentioned in it about the funding model, except that the NHI programme would cost R256 billion by 2025 and possible funding sources were direct taxation, indirect taxation, payroll taxation and premiums (membership contributions).

Urbach weighed in on the uncertainty around the NHI funding model, saying: “The funding sources proposed in the white paper will be difficult, if not impossible, to implement.

“Government should use funds already at its disposal and not impose further taxes on an already overtaxed population. Proposed mandatory payments into a central NHI fund will crowd out private insurance as many individuals, who will be unable to pay voluntary private insurance premiums, will be forced to move to an already overstretched public health service.”

On Friday, Motsoaledi said the SA Private Practitioners’ Forum and the Free Market Foundation were dividing the nation between the rich and the poor. “They want a new kind of apartheid, where the rich do not mix with the poor. That is a completely outdated model of healthcare. It is also contrary to the Constitution.”

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