While some of the proposals contained in the newly released National Health Amendment Bill (National Health Insurance (NHI) Bill) are reasonable, and keeping with the principles of the universal access to healthcare, notably for the most vulnerable of the South African population, many aspects are vague, and require more detailed clarification. This is according to the South African Medical Association (SAMA).

The Bill, along with the Medical Schemes Amendment Bill, was released by Health Minister Dr Aaron Motsoaledi in Pretoria last week.

“There are aspects of this Bill, and the Medical Scheme Amendment Bill, which we welcome. But there is too much detail which is lacking. Sadly, given the enormous challenges with public sector healthcare provision, any grandiose ideas for healthcare are not shared; our members would simply ask for a functioning system first and foremost,” said Chairperson of SAMA, Dr Mzukisi Grootboom.

Dr Grootboom added that SAMA questions the practicality of the timelines for the implementation of NHI as set out in the proposed legislation.

“We would’ve hoped government would present a clear and coherent plan for the revitalisation of the public healthcare system that is so desperately needed. Government must also realise that the human resources we have in our healthcare system – both public and private – are not a dispensable commodity, as is unfortunately how they are sometimes perceived and dealt with,” said Dr Grootboom.

SAMA noted that they have a number of concerns in relation to the NHI Amendment Bill. First amongst these is the fact that the intended right to expand access to healthcare does specifically refer to access to high quality healthcare. It is imperative that NHI must not result in quality of care lower than that which medical scheme beneficiaries currently experience.

“Instead, NHI should seek to address the quality of care currently not enjoyed by non-medical scheme beneficiaries. Currently, the state has not proved it is competent to provide good quality of care, and there is no certainty that the NHI Fund (the fund which will administer NHI) will be able to contract services with private providers. This may necessitate duplicative medical scheme cover to avoid violation of rights to quality healthcare,” said Dr Grootboom.

Dr Grootboom added that other provisions, such as the fact that the Bill encourages doctors to provide services at the ‘lowest possible price’ can only be accepted if these tariffs are reasonable and consistent with realistic costs of service provision.

As for the Medical Schemes Amendment Bill, Dr Grootboom said there are again issues that require further clarification.

“For instance, we support the abolishment of brokers as they have dismally failed to show their value in the private healthcare system and this will also aid reducing non-healthcare costs. However, any money saved from this must be used to expand health services. Doing one without the other is, in our view, counter-productive,” said Dr Grootboom.

Dr Grootboom added that a more thorough unpacking of the Bills has commenced and that SAMA will continue to engage with both its members and the government on the issues.

“At the basis of everything, though, must be an understanding that medical professionals provide an essential service to our country and their value cannot – and should not – be underestimated or devalued,” said Dr Grootboom.

“At the same time we will need to understand in greater detail exactly how government plans to unpack this legislation, the time frames it intends doing this in, and the impact all of this will have on healthcare provision,” concluded Dr Grootboom.

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