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Disputed health bills head for heated debate

Health Minister Aaron Motsoaledi released two bills on Thursday that pave the way for sweeping reforms to the healthcare system.

Both are likely to lead to heated debate with private sector providers over what is a fair rate for their services.

The National Health Insurance (NHI) Bill seeks to establish a fund that will contract with accredited public and private sector providers to pay for healthcare services for its beneficiaries, as the government realises its ambition for providing universal healthcare. A crucial aspect of this plan will be the mechanism established to determine what the fund will pay hospitals, doctors and other healthcare professionals.

“It is likely to be a difficult process to determine a fair price for both sides,” said Insight Actuaries & Consultants joint CEO Barry Childs.

The National Health Insurance Bill was released for public comment with the Medical Schemes Amendment Bill.

The changes planned for the medical schemes industry were intended to align it with NHI and provide greater protection to consumers, said the minister.

“The implementation of NHI … will take place in a phased-in approach. While this is happening medical scheme beneficiaries need immediate relief from serious challenges experienced … in the current regime.”

The Medical Schemes Amendment Bill contains measures to improve scheme governance, expand mandatory benefits to include more primary healthcare cover and regulate broker fees more closely.

While it does not detail the fees healthcare providers may charge medical scheme members, the minister reiterated his stance that there should be a uniform tariff.

“We cannot continue to run a system where people are paid differently for the same services,” he said.

Section 29 of the Medical Schemes Act contains provisions that say claims must be paid according to a schedule. It is understood that the Department of Health intends to use this to

specify tariffs. How these tariffs are determined and the extent to which healthcare providers will be able to deviate from them is likely to elicit heated debate.

Alex van den Heever, chairman of Social Security Systems Administration and Management Studies at the University of the Witwatersrand, warned that the governance structure envisaged for the NHI Fund was vulnerable to corruption, as it vested too much power in the minister.

The bill gives the minister the power to nominate, appoint and remove board members, which are functions that should not all vest in the same individual, he said. “Every state institution with the board structure of the NHI Fund has been captured,” Van den Heever said.

Werksmans attorney Neil Kirby questioned the wisdom of introducing enormous reforms into an already strained system.

“Whilst the proposed NHI may … satisfy the requirements of government’s obligations to progressively realise access to healthcare services, [it is a] paper-based set of aspirations largely divorced from the realities of public sector infrastructure problems and endemic capacity constraints…. It’s a bit like building a house with no land on which to put it,” he said.

The minister said he was aware of the problems confronting the public healthcare system, but improving its quality was an ongoing task and NHI could not wait for that to be complete.

NHI is a set of health financing reforms that the government hopes will change deeply inequitable access to healthcare, in which wealthy people pay for generally high-quality private healthcare services while less well-off people depend on a patchy public healthcare service. It plans to introduce universal healthcare that is free at the point of delivery for everyone, based on the social solidarity principle that those who can afford to do so will subsidise those who cannot.