HASA CEO, Dr Dumisani Bomela

This opinion piece by
HASA CEO Dr Dumisani Bomela appeared in the Sunday Independent on 3 March 2019

It is unfortunate when stridently opposing parties use
misleading language to further their particular aims at the expense of what
should be a thoughtful and carefully calibrated debate on the issue that
affects every South African.

I am referring to the language used in the piece headlined
“Great Debate on the National Health Insurance” that was published in the
Sunday Times on February 17. On one hand, in this debate, the Free Market
Foundation, which is staunchly opposed to the NHI, presented its views; and on
the other, the Minister of Health, Dr Aaron Motsoaledi, understandably came out
strongly on the side of the NHI. Both, however, drew the Hospital Association
of South Africa (HASA) into the fray and sought to characterise it – directly
and indirectly – as being opposed to the National Health Insurance. This is
simply not true. Hasa’s stance has been consistent over a protracted period. In
various forums – including the Presidential Health Summit – we have contributed
research, evidence, and our experiences gained internationally in countries
where our members have operated in universal healthcare environments – all with
a view of providing perspectives to help successfully accelerate access to
quality healthcare for all in this country.

Hasa has never stated opposition to the NHI. To the
contrary: At the annual Hospital Association of South Africa conference in
2017, two private hospital groups’ chief executives made clear from the podium
their willingness to positively contribute to interventions to achieve
universal healthcare. Then as now, however, an accompanying appeal was made for
increased policy clarity and urgent collaboration. During the ongoing debate
regarding the tabled proposals for NHI, we have asked probing questions, and we
have made challenging statements as any responsible person or institution

The intention has always been to create a better
understanding of the proposed reforms, to point out their anomalies and areas
of uncertainty, and to focus minds on the necessary and critical steps that we
must take to deliver health services and good policy. Seeking these outcomes,
no matter how uncomfortable, should not be hastily construed as oppositional as
this may lead to misunderstandings such as has occurred in the “Great Debate”
where discussions on a specific topic have been quoted out of context and have
become misleading.

At a recent meeting of the Public Private Growth Initiative,
hosted by Business Unity South Africa, a number of sectors discussed ways to
collaboratively grow the economy. Inevitably, the constraints to national
economic growth came into focus – including policy uncertainty and its effects.
Similarly, during HASA’s presentation, areas of healthcare policy uncertainty
were highlighted – including the role of medical schemes under the NHI; and the
meaning and impact of Clause 54 (4) (g) in the NHI Bill.

Both have a potential effect on economic growth and on the
private healthcare sector. To examine each more closely, the Medical Scheme
Amendment Bill reserves the right for the Registrar of medical schemes, in
consultation with the Minister, to disallow medical schemes from covering the
same benefits as those covered by the NHI, creating uncertainty around the role
of medical schemes and the benefits available to consumers; and in Clause 54
(4) (g) of the NHI Bill, it appears that hospital services will be procured by
the NHI Fund only from public hospitals, post-2026, despite other assertions in
the Bill that services will be procured from public and private service

In his State of the Nation Address, President Ramaphosa made
it clear that the fund will procure from both public and private sector
suppliers, yet, as far as we know, Clause 54 (4) (g) remains. To impute from
such a discussion that HASA is opposed to the NHI is to misunderstand the
context and purpose of the session quoted and responded to in the “Great

A second matter arising from the “Great Debate” is the
Minister of Health’s response to the Free Market Foundation, regarding the
Minister’s question as to whether the opposing view to his own was penned at our
behest, while admitting that this is something he may not know. We can assure
him that this is not the case. Far from being opposed to the NHI, HASA will
respond to the President’s call for all South Africans to work collaboratively,
using their skills and resources, to find solutions to our common challenges;
we will therefore continue to positively contribute in any and all available
forums where there is a concerted, transparent, collaborative, and committed
effort to find ways to create and/or improve access to quality healthcare for
all South Africans.