Claims by the private sector that low-cost medical aid is being blocked are a “sideshow” to National Health Insurance (NHI), says Nicholas Crisp, who is driving the government’s health plan.
Crisp, the deputy director-general of the national health department, spoke to the FM after Business Unity South Africa (Busa) urged the Council for Medical Schemes (CMS) to discuss the long-delayed regulation of low-cost plans.
He was responding to accusations by the Board of Healthcare Funders (BHF) that the regulator was blocking plans to boost universal health coverage.
Discovery Health is preparing to offer cheaper health insurance of between R300 and R350 a month if it gets approval from the council. Discovery says it will take pressure off the state.
The issue is to be decided in the Constitutional Court next month.
Crisp says medical aids and the NHI have competing demands and that it’s not about the CMS “dragging its feet”. “There are some people who want to make money and others trying to deliver health care,” he says. “There’s massive stakeholder consultation, statutory processes and more that must first take place.”
Crisp says the government does not regard health as a financial commodity. “We see it as a public good, which is why we want the NHI implemented as designed rather than fiddle at the edges trying to make companies more profit.”
He says the low-cost plans will make no difference. “Ask a few GPs whether prefinancing consultation is better than out-of-pocket payment. All you get is a broker and medical schemes creaming off 15%, which goes into the company coffers and makes no difference to those who pay,” he says.
He also says the low-cost plans have been “watered down” to compete with insurance products. He says the government agrees with the health market inquiry, which investigated private health care and recommended a single common compulsory package.
The government could use data from the provision of these low-cost products to fine-tune benefits in the NHI
— Katlego Mothudi
BHF CEO Katlego Mothudi says in 2016 the court gave the CMS two years to establish regulations ruling that medical aid schemes, not general insurers, should establish low-cost benefits. “Since then, there’s been extension after extension,” he says, adding that the department and the CMS “could have moved faster”.
He says the BHF does not see cheaper medical aids as competition to the NHI. “The government could use data from the provision of these low-cost products to fine-tune benefits in the NHI.” One BHF survey found that up to 45% of households reported at least one family member using the private sector as a primary point of care.
Medical aids are seeking reconsideration of a part of NHI draft legislation that allows private medical funders to cover only products and services not covered by the state. No detail is spelt out in the proposed bill, but Crisp says this will evolve.
“When the benefits are defined, say in 2027/2028, and money is shifted out of the National Treasury into the budget, it may happen,” says Crisp. “Medical aids will continue and, just as the health market inquiry said, we’ll end up with one common compulsory option that all medical aids must cover. It could be that [this] becomes the basis for year one of the NHI. But the government does things in three-year cycles; it’ll be a while before we get to that space.”
He says the debate is whether the state or the free market is responsible for health care. “This has nothing to do with ideology. It’s pure public health to benefit as many as possible. It’s about the most efficient way to do things, not about making a profit.”
He says the private health-care industry does a splendid job, but “profit-taking in that space is not appropriate. Harnessing all those resources to a few people because of profit-making is not good for the country or the taxpayer.”
Speaking after this month’s presidential health summit, Busa nonexecutive director Stavros Nicolaou says the NHI Bill, as it stands, will make medical aids unsustainable.
He says there is “no argument with the moral imperative of universal health care” but that there is frustration over regulatory lag, red tape, the administrative burden and a lack of regulatory reform. “This prevented the private sector from taking on more public sector patients during Covid.”
Crisp says the NHI envisages a single purchaser (the state) procuring virtually all health-care services and products while entering into contracts with private contractors, whose payment will be linked to the quality of demographically tailored, disease-appropriate services.
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