Policy document finally released, but expert labels it absurd, superficial, irrational
SOUTH Africa’s middle class will not be able to use medical aids to fund most private healthcare procedures if National Health Insurance becomes law, and will pay more in tax for the NHI system.
Health Minister Aaron Motsoaledi released the NHI policy document for public comment on Friday after having promised its “imminent” release for the past three years.
The white paper explains that the NHI, if passed into law, will consist of a single, staterun fund that pays for all health services for all.
Contributions to the fund will be mandatory. The fund will pay the state and private sector for services, but it is not clear who will be allowed to use private hospitals and who will use state hospitals.
Medical aids will only be allowed for what is not covered by NHI and will exist as “complementary cover”.
“With the implementation [of NHI] the role of medical schemes in the health system must change,” the paper says.
Healthcare management company PPO Serve’s chief executive Dr Brian Ruff said: “This proposes the end of private comprehensive medical aid cover. Chemotherapy, a heart bypass operation or any major health procedures will be purchased by the NHI fund.
“Medical aids will be for topup care, or for minor, elective procedures and for what the NHI doesn’t cover.
“But what exactly the NHI won’t cover is not yet defined.”
The document predicts that there will be far fewer medical aid schemes than the current 83 and a change of existing laws will be needed to bring the policy to fruition.
Government medical aid schemes such as the Parliamentary Medical Scheme, SA Municipal Workers’ Scheme; police medical aid Polmed, and the Government Employees’ Medical Scheme will reallocate the monthly premiums they earn from workers into a single NHI fund.
This fund, which would be for all people, could mean the middle class will be forced to use the state sector.
The policy document states that when the NHI is “fully operational”, the tax credits that medical aid users earn each month will be revoked and redirected to the NHI fund.
It suggests households will spend less on medical scheme contributions and more on a “general tax allocation” towards the NHI fund.
The document calls for a “complete reform” of the health system in both the way services are provided to the sick and how doctors and hospitals are paid.
It states health must not be treated “as a commodity, but a social good”.
The paper speaks of a redistribution of resources, saying there is too much inequality in the sector.
It slams the fact that 16% of the population using private healthcare spend the same amount each year as the government spends on 84% of people using the state sector.
The NHI plan states that doctors are over-represented in the private sector, saying there is a “maldistribution” of resources.
It blames the private sector for high salaries that have to be paid to government doctors to entice them to remain in the state sector and suggests making doctors work where they are most needed.
“The health workforce is a key pillar of the health system and the planning and distribution will be further improved to meet the needs of the population,” it reads.
A health expert, speaking on condition of anonymity said: “The policy paper is absurd, superficial and irrational.
“No aspect will survive a legal challenge.
“Instead of trying to improve health services in the state sector, it is attempting to change how health services are provided to people with medical aid.
“It is focusing on 9 million people who already have good healthcare.”
On Friday, Motsoaledi said it was not yet determined how the NHI would be paid for.
The document suggests various tax increases from upping VAT by 2%, deducting NHI contributions from salaries or increasing personal income tax.
It states it does not think tax will rise too high, but rather envisions moving spending on private healthcare into the public sphere.
The Board of Healthcare Funders – the medical aid industry body – declined to comment.
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