Health professionals raise concerns about NHI single-payer model

The signing of the National Health Insurance (NHI) has tongues wagging on whether it will work or not.

The matter has since been a critical political discourse and was often at the forefront of election campaigns.

Profmed CEO Craig Comrie said the NHI Act has been the cornerstone of many political campaigns. He pointed out that the emphasis on the NHI might have overshadowed other critical aspects of health care.

The concerns that he raised highlighted the broader debate around the single-payer model proposed by the NHI.

“While this model might address issues of equality, it also raises questions about freedom of choice in health care. Countries that operate successful universal health-care models don’t rely on a single-payer, single-funder model as described in Section 33 of the NHI Act, which limits the role of medical schemes.

“This section infringes on the freedoms of the health consumer and avoids competition between the NHI Fund and medical schemes, which remains particularly draconian,” he said.

Even though Comrie believed that the future of the NHI was hanging in the balance due to the Government of National Unity (GNU), he reckoned that the GNU partners should use the bill as a critical benchmark for its success.

“The goal is clear: to provide access to all while ensuring high-quality service delivery. We need reforms that deliver better service across South Africa. What we need are well-thought-out, well-researched, evidence-based reforms,” he explained.

Other health-care professionals echoed Comrie’s sentiments, for example, Dr. Langani Mbodi, President of the South African Medical Association Trade Union (SAMATU), who emphasised the need for collaboration between private and public health-care sectors.

“The general population currently lacks access to adequate health care and NHI has the potential to address the inequality.

“However, to successfully address the inequality, we need collaboration between private and public health-care systems, which is possible, as evidenced by the Covid-19 pandemic,” Mbodi explained.

He also highlighted disparities in health-care delivery while sharing the example that even private patients access pockets of well-functioning public sector facilities for treatment.

“The disparities of the level of services, in general, are growing, for instance, cancer patients in the private sector receive timely screenings and results, while those in the public system face prolonged waiting periods.”

Mbodi asserted that this stark contrast underscores the need for a more integrated and efficient health-care system. Furthermore, he said the use of excess capacity in the private sector can alleviate public sector queues.

Speaking about the role of medical schemes, Dr. Thandi Mabena, Chair of the Council for Medical Schemes, asserted that the Medical Schemes Act remains a vital guiding document.

“The Act will still be relevant, and there will likely be amendments.

“As a country, we need to work together to find solutions that prioritise the interests of our nine million members on medical schemes and those that cannot afford medical schemes,” Mabena said.

A health-care practitioner and founder of Your Health, Your Dignity, Dr. Moratwe Masima shared his experience in both public and private sectors, saying that in the public sector, patients were often referred to different places, which according to him was a huge disservice.

“We are overworked and understaffed, yet many health-care professionals are unemployed. Reforming our IT systems is also crucial to avoid losing patient information,” said Masima.

Overall, all the panellists agreed that as South Africa embarks on this new political chapter, the next few years will be critical for health care. Preventative care, such as screenings, must be a priority.

“The GNU’s collaborative approach offers hope, but effective implementation and continuous evaluation will be key to achieving the envisioned health-care reforms," Masima concluded.

Saturday Star

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