Industry readiness is a moot point
After many years of deliberation, the Department of Health released the National Health Insurance (NHI) Bill on 8 August. If government has its way, the Bill will be implemented as soon as possible with 2026 the most recent date provided for possible full implementation. The Bill has been met with mixed reaction and has split the country down definite lines. Many have voiced their support for the system while others have questioned whether the NHI is the best fit to replace the current healthcare system. It seems as if the country’s readiness for the NHI is a moot point within political circles.
Of concern to the financial services industry is the fact that the Minister of Health, Dr Zweli Mkhize has adamantly stated that there will be a lot of changes in store for medical schemes in a healthcare system that is dominated by the NHI.
According to the Bill, once the NHI has been fully implemented, medical schemes may only offer complementary cover to services not reimbursable by the NHI.
Industry reports point out that if a patient wants to see a specialist under the NHI model, they will have to go through the primary healthcare system who would refer the patient on because they do not have the skills to help them.
This is where clarification is needed. The NHI has explicitly said that it will not pay for patients who go directly to specialists without accessing primary healthcare. If the patient is a member of a medial scheme and wants to see a specialist, will the NHI allow the medical scheme to foot this bill?
What does the future hold?
Following the release of the NHI Bill, Discovery Health made a statement which provided their reaction to the Bill.
Unfortunately, because Discovery Health is still engaging with Dr Mkhize on key issues, specific questions could not be answered at this stage.
“In terms of the future role of medical schemes, we are studying the details of the Bill as these are not entirely clear, and we will engage with Dr Mkhize and the Department in order to understand the implications of the Bill. We firmly believe that once South Africans have contributed to the NHI, they should have the freedom to purchase cover through medical schemes for any healthcare services, including those provided by the NHI, should they wish to do so,” said Discovery Health CEO Dr Jonathan Broomberg.
This is obviously the best outcome that the industry can hope for. However, it comes with a major challenge.
Medical scheme premiums have been expensive for a long time with increases well in excess of 6%. Perhaps the NHI will resolve this, but what if it doesn’t? Will those who can just afford to pay medical premiums now be able to afford to foot the bill of medical premiums as well as the tax towards the NHI? Probably not.
What about the broker?
If the Department of Health does not allow the public to purchase healthcare cover from medical schemes in addition to contributing to the NHI, what will happen to medical scheme brokers?
Will this not result in massive unemployment? How can government say that it is committed to addressing the unemployment issue if this is the case?
“We look forward to working constructively with the Minister and the Department of Health to obtain clarity on various aspects of the NHI Bill and will work hard to contribute towards the successful implementation of the NHI system,” said Dr Broomberg.