Health Minister, Zweli Mkhize

Health Minister Dr Zweli Mkhize has described as unfounded the fears of critics of the Draft NHI Bill that National Health Insurance will effectively nationalise the private healthcare sector and open the healthcare system to the corruption and plundering that have taken place in state-owned entities such as Eskom.

Speaking at the Hospital Association of SA (HASA) conference in Cape Town, the Minister was quick to assure private hospitals and healthcare practitioners that there was no attempt from government to take over private providers, but that it will contract with willing partners in the private healthcare sector to provide services when NHI is implemented. He, however reiterated that pricing in the private sector remains a problem, saying that South Africa spends more on healthcare than most other countries. According to Mkhize, the Presidential Health Compact signed last month and the work that preceded its drafting have prepared the way for intensified collaboration between the two sectors. He also assured delegates that there will be thorough engagement with both sectors in finding ways to correct and turn around the widening gap in equality to access quality care in South Africa.

NHI Fund structure not open to corruption

Mkhize said while he welcomed the robust debate that followed the submission of the Bill to Parliament earlier this month, a lot of false information was spread, particularly around the proposed NHI Fund’s centralised management structure, which critics say will leave the system wide open to corruption. He explained that the Fund will be a Schedule 3 entity that will be set up like institutions such as the Medical Research Council and the Human Sciences Research Council. According to Mkhize, this will prevent board members from taking risky decisions with the money made available for the purchasing of health services. In addition, a strong anti-corruption team similar to the Special Investigating Unit will be created within the Fund, the Minister promised.

He also denied that the NHI will be bankrupting the country and that his department and national Treasury were not seeing eye-to-eye on the funding for the system. Mkhize said while Treasury has calculated that there will be a shortfall of around R30 billion by the 2026 target date for implementation, internal discussions are being held and that a money Bill, that will govern the funding of NHI,  will be tabled soon.

Medical schemes will have a role

He reiterated that the NHI will be a single-payer model but emphasised that medical schemes will still have a role in paying for services not provided by the NHI and services required by individuals who choose not to be part of the proposed system and its rules. He denied speculation that there will be massive job losses if schemes are relegated to offering only top-up services.

“There is a role for them [people working in the medical scheme industry] as government needs their skills in managing health financing,” Mkhize said

“We need to look at how the entire system can benefit the whole country and economy. There is space for everyone to adjust to the new environment. It’s premature to say where the losses will be. We need to explore the gains,” he noted.

Through NHI, primary healthcare will be strengthened through community-based clinics, using multi-disciplinary teams.

“This provides scope for various other allied healthcare service providers. It holds space for homeopaths, acupuncturist and traditional healers. We still need to work out how to align traditional Western medicine with alternative healthcare suppliers,” Mkhize explained.

Private hospitals ready for the challenge

Opening the conference HASA Chair, Dr Biren Valodia said South Africa is embarking on perhaps one of the most seminal moments in the history of the country due to the planned and much-debate health reforms and the rapidly changing healthcare environment.

He said despite the magnitude of healthcare challenges the country currently faces, he remains optimistic because of the greater willingness and acceptance of collaboration. One of the examples is the Public Enhancement Fund that has invested millions of rand into the training of doctors from the poorest rural areas and provided funding for poor students to obtain their PhDs and Masters’ degrees.

Referring to a HASA board decision earlier this year, Valodia said this has expanded the association’s mandate to play an integral part in finding solutions to the challenges facing healthcare.

“One question stood out for us and that is how do we contribute to increase and improve access to quality healthcare for all South Africans. This resulted in a newly overhauled structure that focuses on the successful delivery of projects to advance healthcare through innovation, collaboration, research and evidence,” he pointed out. One of the envisaged projects is the offer made by private hospitals at the Presidential Job Summit to train 50 000 nurses.

“We want to place healthcare on firm foundation and use every opportunity open to us to improve and increase access to quality healthcare,” Valodia concluded.