News Desk | NHI | Editorial
 

The first NHI regulations set for public comment as experts continue to weigh in on the scheme's feasibility

Time to read: 03:31 minutes
Time to listen: 05:52 minutes
 

14 October  2024
Editorial by Linda Ravenhill

According to a recent article in Spotlight, the Department of Health is preparing to release the first draft regulations related to the National Health Insurance Act, which are expected to be published for public comment within the month.

Dr. Nicholas Crisp, who heads up the government's NHI implementation project, has indicated that these draft regulations will cover sections 12 to 30 of the Act. These sections are crucial, as they will lay the groundwork for selecting and appointing the NHI board, advisory committees, and the CEO. Once the public consultation is complete, the Health Department will move forward with these appointments.

Exactly how the NHI will roll-out from here onwards remains uncertain. In early September, President Cyril Ramaphosa and senior government officials held talks with business leaders, an effort to indicate that the government was 'open to dialogue' on the numerous sticking points and concerns that had been raised by business and private organisations. 

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At that meeting, the President stressed the importance of constructive dialogue, urging businesses to present proposals rather than criticism. Business Unity South Africa (BUSA), one of the key organisations involved in the discussions, is due to present its alternative proposal to the government by the end of October. BUSA is advocating for changes that would allow private medical schemes to continue operating alongside the NHI—the so-called hybrid model.  

The NHI Act in its current form, states that medical schemes will not be able to cover services that the NHI fund pays for once the system is fully operational. This has raised concerns among industry leaders, who fear the collapse of the private healthcare sector if the Act is not amended. Cas Coovadia, CEO of BUSA, has argued that a balance can be struck that protects private healthcare while achieving the NHI's goal of universal health coverage.

For more on this particular aspect of the debate, we recommend listening to an interview by Mia Malan from Bhekisisa, featuring Cas Coovadia, BUSA's CEO, and Olive Shisana, President Ramaphosa's special adviser.

  

As Spotlight notes, there are three potential scenarios for how the NHI could develop. The first is a "pure" NHI, where the system operates as a single state-run purchaser of healthcare services, and private insurance is phased out for most services. The second scenario is the aforementioned hybrid model, where both public and private health services coexist. The third, less optimistic scenario is that the NHI may never get off the ground, hindered by financial constraints and institutional challenges.

Crisp has acknowledged that full implementation of the NHI could take decades, with initial phases focusing on primary healthcare. Once the financial and administrative structures are in place, the NHI fund will begin purchasing services for vulnerable groups, such as children, older people, and people with disabilities. However, according to Crisp, this is unlikely to happen before 2026, and there are significant hurdles, both fiscal and institutional, that could derail the NHI. 

Professor Alex van den Heever from the University of the Witwatersrand has warned that the government may not have the capacity to manage such a large, complex system and that existing public healthcare resources are already stretched thin.

Furthermore, the NHI's financial viability remains a point of concern. The government will need to raise additional tax revenue to fund the NHI, but economists have warned that South Africa's tax base is already under pressure. Without sustained economic growth, the state may not be able to generate the necessary funds to keep the NHI afloat. The NHI could end up as an unsustainable program, riddled with the same issues that have plagued other large-scale government initiatives.

For now, the release of the first draft regulations marks a pivotal moment for the NHI, but the scheme's long-term future remains highly uncertain. With negotiations between the government and private sector ongoing, the next few months could be crucial in determining which path the NHI will ultimately take.

This story was compiled from various sources, including:
8 October 2024 | Spolight | How will NHI unfold? Here are three possible scenarios
 

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