Reckless implementation of NHI ‘may lead to mass exodus of doctors, specialists’

South Africa’s NHI would see patients consulting with NHI-accredited doctors and the NHI Fund paying those doctors. Picture: iStock
South Africa’s NHI would see patients consulting with NHI-accredited doctors and the NHI Fund paying those doctors. Picture: iStock

South Africa’s imminent new National Health Insurance (NHI) has been met with mixed reviews by industry players.

While the Health Funders Association has indicated its support for the new funding model, doctors, anaesthesiologists and analysts have warned that it needed to be approached with caution.

Rolling out the National Health Insurance Fund blindly will have severe consequences for the country, the South African Society of Anaesthesiologists warned on Tuesday.

Briefing the media on the legislative changes expected in the country’s healthcare system, the organisation expressed concerns that there would be a mass exodus of doctors and specialists if the new funding model was implemented recklessly.

City Press reported on Sunday that there were four factors that would determine the success or failure of the NHI, as the government last week released two new bills to enable its establishment.

These are funding, collaboration between the public and private sectors, the availability of a skilled workforce and management – including avoiding corruption, said Nicholas Burger, a healthcare consulting analyst at market research company Frost & Sullivan.

Health Minister Aaron Motsoaledi last week published the NHI bill and the Medical Schemes Amendment bill.

The aim of the NHI was to provide healthcare services to all South Africans, regardless of their income level.

Motsoaledi explained that under the system, the rich will subsidise the poor, the young the old, and the healthy the sick.

The system is scheduled to come into effect in 2026.

But health professionals have called into question the viability of the NHI when there is already a shortage of professionals.

“We need to ask ourselves how we are going to make NHI work when we do not have people to ensure that access is better,” said the anaesthesiologists society’s vice president, Dr Lance Lasersohn, who works in both the public and private sector.

The organisation called a briefing following reports in the Sunday Times that analysts had warned that the state-regulated fees planned by the NHI would drive doctors out of the country.

According to a City Press report, once implemented, patients would reportedly be required to consult with NHI-accredited doctors and the NHI Fund would pay those doctors.

Business Live reported on its website that analysts anticipated a mass exodus following the deadline for responses to the white paper on the NHI, released by the health department in December.

During his presentation, Motsoaledi explained that an NHI Fund would be established as a public entity, which would be governed by the Public Finance Management Act.

The fund will be a single public purchaser and financier of health services in the country to ensure “equitable and fair distribution” and will be a mandatory pre-payment health services system.

Healthcare services, medicines, health goods and health-related products from certified, accredited and contracted service providers would be financed by the fund.

It would “pool funds to provide access to quality health services for all South Africans based on their health needs and irrespective of their socioeconomic status”, the minister explained.

The ultimate goal of NHI is to ensure that everyone has the same access and standard of healthcare, regardless of their income.

The NHI Bill will also require amendments to 12 other pieces of legislation in order to pave the way for an effective national fund.

Lasersohn said he knew and understood that the NHI’s aim was to make healthcare more affordable for South Africans.

“It is also about providing the public with access to the healthcare not at a high quality but not at a low quality either,” he said.

Lasersohn added that the organisation conducted a survey on the cost of healthcare globally.

“In wealthy countries the government contributes a lot more, while in South Africa, in truth, government contributes about 4.1% and the rest (4.7%) comes from your pockets.”

In 2015, there were about 8.8 million people on medical aid and R138.7 billion was paid in benefits.

He said in South Africa, the service in the private sector was similar to the standards of wealthy countries.

On access to health care, he said the country could build state-of-the-art hospitals, but hospitals will not provide access, people will.

The survey found that 60% of people working in the public sector were willing to move over to the private sector because of better remuneration, better working conditions and better access to equipment, among other reasons.

They were however concerned that moving to the private sector would threaten the clinical autonomy of the profession because it could be profit driven.

Lasersohn said he was also concerned about the brain drain following the uncertainty on the implementation of NHI.

“A total of 482 people want to leave the practice for various reasons, mostly uncertainty. We need time to develop the profession and deliver quality healthcare to the public.”

Lasersohn said the NHI would work if the country went back to putting patients first and professionals second.

“This means high ethics and integrity when dealing with the public. We need to sort out governance issues and we need to be more sustainable financially. We cannot afford to ignore these threats.

“There is a perception that the NHI is the silver bullet, but we are saying there are consequences in rolling out the NHI blindly.”

The society’s chief executive Natalie Zimmelman said the attitude towards NHI was overwhelmingly negative.

“This is a problem and we need to deal with it as professionals, clinicians and South African citizens.”

She said one of the biggest concerns about implementation was the impact it would have on the professions workforce.

Zimmelman said organisations were willing to work with the government to find a lasting solution.

Meanwhile, the Health Funders Association, which represents about 73% of all open schemes and 53% of the total medical scheme membership, welcomed the release of both the NHI Bill and the Medical Schemes Amendment Bill because they provided some clarity on government’s intention with regards to financing, provision, governance, and regulation of the NHI and the lead up to a sustainable model that will adequately support universal health coverage to deliver on the objectives of government.”

“The Health Funders Association unequivocally supports the need for universal health coverage which is affordable and equitable and we will be formulating a submission to the minister which will clearly articulate our position and make recommendations that will take into consideration the pivotal role which the private health sector can play in achieving universal health coverage,” said head of the association, Lerato Mosiah.

Mosiah pledged the association’s commitment to working with government and added that the expertise, infrastructure and other resources which reside in the private sector are valuable assets which could assist in realising universal health coverage.

Additional reporting by News24


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