News Desk | NHI
SA Doctors Propose Patient-Centered Healthcare Reform as NHI Alternatives
Time to read: 05:55
Time to listen: 08:28
11 December 2024,17:30
The Universal Healthcare Access Coalition (UHAC), which represents the majority of healthcare professional associations in South Africa, has put forward a significant alternative to the National Health Insurance (NHI) in a bid to address the country’s healthcare challenges. The coalition presented its proposals to President Cyril Ramaphosa, aiming to shift away from the controversial NHI model. While the NHI is the African National Congress (ANC)'s initiative to provide universal healthcare access, it also seeks to dismantle the existing medical aid system in South Africa. UHAC’s alternative, however, advocates for strengthening and expanding the current medical scheme system.
The NHI plan intends to create a government-managed fund to finance medical services for all qualifying individuals, diminishing the role of private health insurance schemes. Although medical aids could technically still exist under the NHI, key sections of the proposed legislation would restrict them from covering the same services as the NHI, which remains undefined. UHAC, in its assessment of the NHI, has expressed concerns that the plan is "fiscally and institutionally unimplementable," particularly highlighting the difficulties in providing comprehensive healthcare coverage for the entire population via a single tax-financed fund. The coalition’s view is that healthcare should be expanded through medical schemes rather than dismantling them altogether.
In its report titled Universal Healthcare Access for South Africa, the coalition outlined the critical obstacles currently facing South Africa’s healthcare system and proposed sustainable reform solutions. These obstacles include significant challenges in both the public and private healthcare sectors, the lack of a strategic health reform policy for over two decades, and an absence of a balanced financing approach to healthcare. UHAC’s report also pointed to the political influence over healthcare governance as a significant issue, calling for the depoliticisation of healthcare management to ensure that healthcare decisions are made based on expertise rather than political considerations.
Current System Challenges
The report outlines several systemic challenges hindering progress in South Africa’s healthcare system:
Public Sector Challenges: The public healthcare system struggles with governance failures, inefficient resource allocation, and a decline in the quality of services. This impacts the overall accessibility and reliability of healthcare in public facilities, leading to overcrowded hospitals and poor service delivery.
Private Sector Struggles: On the other hand, the private healthcare sector faces rising costs and regulatory gaps in medical schemes, which are limiting access to care and affecting the sustainability of medical schemes. This has led to the exclusion of a large portion of the population from private healthcare access.
Policy Vacuum: A 20-year policy vacuum has stalled strategic health reform in South Africa. Although the NHI proposal was put forward as a solution to address these gaps, UHAC argues that the proposal is not fiscally or institutionally feasible. The coalition fears that the NHI’s approach could lead to the continued deterioration of both the public and private health systems.
Imbalanced Healthcare Financing: UHAC highlights that the current system lacks a balanced approach to financing healthcare, which could provide for universal healthcare access. It argues that a combination of tax financing and private contributions is essential, as seen in other countries with successful healthcare models.
Political Influence on Healthcare: The coalition also stresses that political influence over healthcare governance is a problem, urging the establishment of a governance framework that ensures independence from political interference. This would allow for more effective management of healthcare systems at both the national and local levels.
Key Proposals
In response to these challenges, UHAC has presented a comprehensive set of proposals for reform aimed at achieving universal healthcare access through a more sustainable and practical approach. These key features of the reform framework include:
Strengthening Public Healthcare Services: UHAC also proposes measures to improve the performance of the public healthcare sector, which has suffered from governance failures and declining service quality. This includes giving more autonomy to district health authorities and public hospitals to make decisions about workforce planning and procurement. The coalition calls for the establishment of a robust governance framework to support these changes, ensuring that local healthcare providers are better equipped to meet the needs of the population.
Expanding the Contributory System: A third major proposal is the expansion of access to healthcare through medical schemes. UHAC recommends making medical scheme membership mandatory for higher-income earners while offering financial support to lower-income contributors. This approach seeks to achieve a more balanced and equitable healthcare financing system. Tax revenues would focus on supporting lower-income households, while a strengthened contributory system would provide coverage for higher-income individuals. To ensure fairness, the proposal includes mechanisms such as risk equalisation and social reinsurance within the medical schemes system, which would prevent risk selection and ensure that all individuals, regardless of their health status, have access to the same level of care.
Moving Forward
In conclusion, UHAC’s proposed reforms offer a more pragmatic and feasible pathway to achieving universal healthcare access in South Africa. The coalition stresses that addressing the governance failures, integrating public and private systems, and ensuring financial sustainability are key to achieving a healthcare system that can truly uphold the constitutional right to healthcare for all South Africans.
The coalition’s proposal represents a balanced approach to healthcare reform, one that acknowledges the importance of both public and private sector involvement while ensuring that healthcare remains accessible, affordable, and of high quality for everyone in the country.
Through these reforms, UHAC believes that South Africa can move toward a more sustainable healthcare system that benefits the entire population, rather than pursuing a one-size-fits-all approach that risks undermining both the public and private healthcare sectors.
Download the report
11 December 2024 | Universal Healthcare Access Coalition | A consensus proposal on a set of achievable strategic healthcare reforms to enable the constitutional entitlement for universal access to all necessary healthcare for all who live in South Africa
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