NHI details urgently needed

6 July 2011
IOL

The eagerly-awaited September government white paper on healthcare reform needs to fill the gaps with much-needed specifics on the planned National Health Insurance Scheme (NHIS) implementation, according to a lawyer on Tuesday.

“Providing universal access is laudable and is a constitutional directive, but we must be certain that we have our eyes fixed on the goal - efficacious and quality healthcare - and not just the promise of it,” says Neil Kirby, director and Health, Pharmaceutical & Life Sciences Practice Area head at Werksmans Attorneys.

The NHI concept is nothing new in larger, wealthier democracies.

“The question is whether such a system is a good fit for South Africa,” says Kirby.

The Obama administration in the US and the South African government appear to be proceeding down similar paths in terms of proposed healthcare reform, though the US progress has been far from smooth.

“The big difference between the US and SA on this is that the American legislation made it mandatory for all US citizens to purchase private health insurance, whereas in South Africa, there is no such obligation to join a medical scheme.”

In essence, Kirby suggests, “the NHIS is basically a large medical scheme - to be governed by a board of trustees in the form of an authority to be created by legislation - and making available only a prescribed set of benefits. These will be provided by a prescribed but legally-accredited set of healthcare providers, including doctors and hospitals for a cost negotiated between the State and the healthcare providers.”

This formula is already in place in the substance of the Government Employees Medical Scheme (GEMS) which, due to its membership and affiliation to the public service.

Kirby describes the present NHIS concept as, ‘the tin man without a heart...it promises access, but access to what?’

The first implementation phase of the NHIS is supposedly set to begin in 2012, and it will make scheme membership compulsory for all South Africans.

Payment for the NHIS will come from a levy or tax deducted from the salaries of formal sector employees, and by the state for the unemployed.