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National Health Insurance Threatens Medical Industry

Author: Melissa Cohen
Date: 2017-08-03
National Health Insurance aims to provide free medical care to all South Africans. But what about the existing medical industry? We find out.
Do you belong to a medical aid scheme? Well National Health Insurance might put a damper on the medical scheme industry and this might affect your cover. National Health Insurance, in theory, plans to provide all people residing in South Africa with free medical care. Many countries abroad have already established free healthcare under the Universal Health Coverage system. The White Paper "Lays the foundation for moving South Africa towards universal health coverage (UHC) through the implementation of National Health Insurance (NHI) and establishment of a unified health system." This will not be so easy for SA as there are many hurdles that the health care system need to overcome first.
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What is National Health Insurance? 

The NHI is a policy that the Department of Health are in the process of implementing. Their aim is to provide free healthcare services to the entire South African population, regardless of your financial status. The project will be completed in a three phase process, which will be fully functioning by the end of 2026. Each phase tackles the various health care challenges that this country is facing, in order to irradiate infectious and deadly diseases. According to the Department of Health's Popo Maja, 84% of the population are not covered by medical schemes.
"NHI will cover quality health care for all, irrespective of socio-economic status. It also covers for financial hardships as healthcare services will be delivered free at the point of care," explains Maja.
The aim would also be to provide the vulnerable members of the community with the first preference when it comes to the NHI.
"According to the section on sources of revenue for NHI, only household earning above R70 000 a month may be required to pay NHI-specific taxes. This will be at a rate of between 0.1% and 3.1% depending on the funding scenario used." Looking for Life Insurance to suit your needs? Look no further!

So What If I Already Have Medical Aid? 

Maja mentions that medical aid members will benefit from the NHI.
"They will also be entitled to comprehensive healthcare benefits instead of fragmented benefits that are currently underpinned by inadequate prescribed minimum benefits and very little on PHC services."
You could still stay on medical aid, make use of NHI, as well as still reap the benefits attached to your medical aid plan.

However, the medical industry thinks differently...

Dr Johan Serfontein from Healthman has emphasized the strain that health professionals will face in the event of NHI.
"It is going to radically reduce the number of medical schemes, who will only be able to cover services not covered in the NHI once it is implemented."
Dr Serfontein explains that medical schemes will only be able to offer complementary services not offered by the NHI. This could be any added benefits like cheaper gym memberships to affordable flights.
"Medical scheme membership will be very expensive. Few people will be able to afford additional taxes and medical scheme on top of that. Rare diseases that will be excluded form NHI will also drive up underwriting costs for schemes. This will lead to high premiums," says Serfontein.
So essentially, if you are on a medical aid plan, you will most likely not be able to afford the exorbitant fees. This will, in turn, mean that you will lose out on various added benefits.

What About Private Practices? 

The Health Department believes that NHI's implementation will only provide positive outcomes for the medical industry.
"Healthcare providers in the public sector will benefit from a better resourced and more accountable and responsive health system. Health care providers in the private sector will also benefit financially as the patient base will be expanded. Whilst there will be more certainty on their potential income especially for PHC(primary health care) providers."
They believe that this system will provide all round economic and social change for the country. Furthermore the department has emphasized that private practices will still earn money but within a regulated environment.
"The central tenant of NHI is saving lives and having a healthy society that is economically active. Money should not determine the kind of health care a person receives."

Private Healthcare, However Has This To Say...

Doctors will be given the opportunity to choose whether or not they want to take part in NHI. This, however, might have negative effects on their income.
"Some doctors will not be contracted with in their current locations (where there is an “oversupply” of providers). They would have to relocate in order to contract with the NHI Fund for services. This might mean having to move to rural areas in order to participate," explains Senfontein.
Another worry that would plague doctors is the salary that the government will be paying them. Government has, in the past, not considered practice cost studies when setting prices. If that does not happen in NHI, doctors might not be able to afford to keep practices open if fees do not cover costs. So if doctors are not being paid enough to stay open, then our healthcare system could worsen its current state.

So, In Conclusion

The World Health Organisation affirms that “UHC does not mean free coverage for all possible health interventions, regardless of the cost. No country can provide all services free of charge on a sustainable basis.” How is South Africa then aiming to provide 100% free healthcare to a country whose president is about to lose his job? This will either mean that NHI will be unaffordable, or the services offered will have to be reduced to an affordable level. This might then be less than what is currently available in the state and private sector. There's some food for thought...
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