What does the Budget have in store for the NHI? Profmed CEO weighs in

Home » What does the Budget have in store for the NHI? Profmed CEO weighs in

Craig Comrie, CEO of medical scheme Profmed, writes about how collaboration with medical schemes will play a key role in progressing to more realistic version of NHI

It is evident there are diverse views on the National Health Insurance (NHI) bill. The NHI will always remain a hot topic fuelled by speculation and political ambitions, but none of us can deny that, for the good of the country, the healthcare system needs to transform.

If we truly aim to balance the scales of healthcare in this country, we are going to need much more than the broad-based policy statement that we currently have that focusses almost exclusively on funding, as the NHI is a health funding mechanism.

Get right down to the details, and you’ll discover that there is scant information to be found. The NHI is still a surface-level discussion. We are many years down this road and inputs to a NHI system began in 2006. It’s a real pity we still have no idea of the benefits it will cover. Worse, we don’t know how it will be budgeted for and financed. In recent comments, the Department of Health indicates that a number of options being explored on how to Fund NHI. These options have been on the table for more than a decade. The whole process is like building a home, without describing how many rooms there are and therefore difficult to establish what the costs are, and how you are going to finance the home.  There is no need to really consult around the need to have a home, and this seems to be the focus of many of the engagements currently with the Portfolio Committee on Health. NHI will probably cost more than R500 Bil per year, but that is not based on any specified list of services still to be determined. It may in important to reverse the thinking and look at what is affordable within the SA context and then use that money to fund a more pragmatic set of services within NHI.

For many years we have heard of the natural stresses between the National Treasury and the Department of Health, but we still have very little detail to dissect. The promised money bill which usually accompanies any new bill is yet to be shared. I the interim we find all the stakeholders including political players making broad statements about the need to improve healthcare and tote the NHI as the panacea. However, as soon as you get to the critical details and start to define NHI in terms of cost, benefits (services) and timelines there seems to be a vacuum of information. The Health Portfolio Committee should consider rerunning the whole consultation process when these details immerge and provide stakeholders the added opportunity to again provide comment and input.In my opinion, it has become moot to discuss the NHI in the philosophical state where it currently stands. Of course, we need to improve healthcare in this country. Everyone is on board with that ambition. This should no longer be the focal point because right now a more pragmatic approach to creating improvement in the healthcare system is required.

Medical Schemes are not businesses, with profit motives and they exist and are owned by their members. Effectively schemes are similar to friendly societies to receive funds in order to cover the healthcare costs of members. The Schemes have effectively removed the obligation on government to provide for these needs similar to the way that private security companies assist the police to protect individuals and their properties.

Medical schemes have been relegated to the play a very small role in the ambitious long term plans of NHI and details in the current Bill reference an end-state when NHI can afford to cover a more comprehensive set of services.

As all structural progress tends to begin and end with money, it is the budget that should become the central point of contention here. I’m not sure there is enough money to achieve the lofty ambitions laid out by proponents of the NHI. If not, then those are the discussion we need to engage in as government needs to make space for the private sector to provide much-needed guidance.

Due to low economic growth projected over the next few years combined with the already overburdened individual taxpayers, NHI will struggle to cover more than a very small set of services leaving the Medical Scheme to provide what is not covered. It is clear medical schemes will be around for many decades to come because there is no space for any added taxes in the form of payroll surcharges without significantly harming the economy in general.

As a member of the private healthcare sector, there is significant value in measuring what is achieved and effective management of health cannot be done without understanding what consumables are being used for which operations, how much theatre time is required or even the types of nursing or pharmacy services are provided and paid for. If you cannot measure healthcare cost at a granular level, you will never create efficiencies. Outcomes based measurements also are measured more clearly because they are funded at an individual level. Managing this, costs more but it  is necessary to drive the right outcomes.

We must have measurement criteria where we can find the best affordable treatment whether in the public sector or private sector and grow efficiencies and effectiveness bases on that information. Medical schemes fund patients in public and private settings and if there is a centre of excellence in the public sector medical schemes would happily refer members to these facilities. The first phase of NHI, after policy development must be focussed on improving the public sector facilities and for members of schemes to choose to go to these improved facilities. This seems a more rational way to redirect the premiums paid to medical schemes, to fund good quality public facilities.

As we look towards the future of this conversation, don’t be surprised if the NHI Bill is adopted soon. But if the details are not sorted out, implementation could be delayed by a number of constitutional challenges which means we lose the opportunity to create better healthcare for all.

The key to unlocking the power of the NHI is not to threaten the existence of the private sector or even the medical schemes industry, but to work alongside it. There is much wisdom to be shared that can create opportunities by working together, we can finally make gains fix healthcare in South Africa.