Introducing the National Health Insurance (NHI) scheme will lead to a wave of doctors and other skilled professionals leaving the country, private healthcare groups have warned.
The warnings were contained in presentations to parliamentarians on the NHI Bill this week.
Businesstech reported that medical scheme Discovery said the scheme in its current form would likely lead to the outward migration of health practitioners from the country through a combination of alternative careers, emigration and retirement.
This would reduce access to healthcare for all South Africans – the core focus of the NHI and universal health coverage.
Discovery said that disinvesting from the private sector and a loss of skills would also lead to medical training being compromised, with a long-term impact on healthcare in the country.
In a separate presentation, medical scheme Bonitas said that a lack of certainty on the role of the private healthcare sector under the NHI would also likely to lead to skills losses.
The scheme said: ‘While it is accepted that the details of comprehensive health care services that will be covered by the fund cannot be included in the NHI Act, it is important that the right for universal healthcare is managed in a responsible manner for the current medical schemes industry, and South Africans are made aware of the services that would be covered.’
Businesstech noted that in August 2021, trade union Solidarity published a report showing that a significant number of healthcare workers planned to leave the country due to concerns about NHI.
The Institute of Race Relations has devoted considerable attention to the risks posed by the NHI scheme, and to alternative proposals aimed at retaining and expanding the best of private healthcare in the country and remedying dysfunction and mismanagement that blight much of the public healthcare system.
IRR head of policy research Dr Anthea Jeffery has pointed out that ‘(universal) health coverage is already available, mostly for no charge, through the country’s public clinics and hospitals’.
‘To function better, these need merit-based appointments, strict accountability for poor performance, and effective action against corruption and wasteful spending.’
Jeffery argues that public-private partnerships ‘would also help improve their operation’.
‘The burden on the public system should also be reduced by increasing access to private healthcare. Low-cost medical schemes and primary health insurance policies should be allowed, while poor households should be helped to join these schemes or buy these policies through tax-funded health vouchers.’
The IRR proposes that, to help spread risks, ‘medical scheme membership and/or health insurance cover should be mandatory for all employees, with premiums for lower-paid employees buttressed by employer contributions for which businesses would garner tax credits. Medical schemes and health insurers would then have to compete for the custom of South Africans, which would encourage innovation and help to hold down costs.
‘The supply of health facilities must also be expanded through regulatory reforms allowing the private sector to establish more day hospitals and the like. Private universities and hospitals should also be permitted to train doctors, specialists, and other health providers, as public training institutions clearly cannot meet the scale of need.’
Jeffery warns: ‘Under the NHI, the State will control every aspect of healthcare. This means the State will decide on the healthcare services to be covered; the fees to be paid to doctors, specialists, and other providers; the medicines to be prescribed; the blood tests to be allowed; the medical equipment to be used; the health technologies to be permitted; and the prices to be paid for every item, from aspirins and ARVs to sutures and CAT scanners.
‘The government claims these controls will be effective in cutting costs and enhancing quality. But the huge bureaucracy needed to implement them will be costly in itself. Pervasive regulation will also stifle innovation, reduce efficiency, and promote corruption.’
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