National Health Insurance Roundtable Dialogue
2 December 2019
Deloitte, Woodmead, Johannesburg
The National Health Insurance (NHI) Bill was introduced to Parliament on 8 August 2019, with a subsequent call for public comment, which expired on 29 November 2019. With the deadline now past, the Inclusive Society Institute deemed it appropriate to host a roundtable dialogue with the critical organisations representing the workers, business and health sector fraternity. The objective of the exercise was to determine the areas of agreement, areas of disagreement, and where such disagreement existed, to seek pathways to reach consensus. Since all the participating organisations had already submitted their comments to parliament, the outcome of these deliberations form a holistic representation as to what can be expected in the parliamentary processes to follow.
Participants in the roundtable included representatives form COSATU, BUSA, the ANC NEC subcommittee on Education and Health, government, private hospitals and medical aids, independent practitioner organisations, health accreditation services, the pharmaceutical and medical equipment supply industry, and the South African National Blood Service. The combined input of these participants, the institute is of the opinion, will fairly represent the views and issues to be raised in the public hearing processes to be scheduled by the parliamentary portfolio committee on health.
As a general departure point, it can safely be expected that general support will be given to the goals and objectives of the NHI Bill, that is the financing of universal coverage of affordable and accessible quality health care. There was general recognition that the current healthcare system is defective, with inefficiencies in both a public and private sector; and that the introduction of legislation to address the problems was therefore to be welcomed.
There was general consensus that the private sector needed to be crowded in, not pushed out, that government and the private sector needed to work together by combining their respective expertise in order to improve the overall healthcare system of the country, and that, in rolling out the NHI, communication between all role-players needed to be improved to ensure an inclusive consultation process.
The main contentious issues that were identified and that required further deliberation during the public hearing process, included the role of medical schemes, the role of provinces, capabilities of the State to manage the NHI fund, and the accompanying governance structures, and how private hospitals will link into the public system. Concerns were also expressed as to the schemes financial sustainability, especially given the constrained economic environment the country finds itself in.
It is section 33 of the Bill which will require the most urgent and comprehensive consultations, with delegates being of the opinion that compromise was required to avoid confrontation. It would, in their opinion, have severe consequences for not only the private medical aids, but so too the whole of the private healthcare system, the loss of cross-subsidisation benefitting the public healthcare system, and negative impact on investment sentiment. The rationality of its insertion was questioned, especially considering its radical departure from the 2018 policies. As presented, section 33, delegates suspected, could also give rise to questions of constitutionality.
A comprehensive report on the roundtable is scheduled for publication towards the end of January 2020.