While private doctors appear to be generally supportive of
the Health Market Inquiry’s recommendations, concerns are mounting that
implementation of the draft National Health Insurance (NHI) Bill and the
Medical Schemes Amendment (MSA) Bill in their current states could be
potentially disastrous to the country’s whole healthcare system.

Some of the main concerns pertain to the perception created
in the two Bills that NHI could be the panacea for fixing the broken public
sector, the lack of clarity on the funding and cost of an NHI, the massive
reorganisation of existing resources that will be required to fulfill the
promise of access to affordable healthcare services for all through the pooling
of state and private money into a single fund, contracting and payment arrangements
with private providers and many more.

SAPPF CEO, Dr Chris Archer says while the HMI’s
recommendations are based on a diagnostic approach that required the collection
and analysis of real data to reach conclusions, this process was totally
lacking in the drafting of the NHI Bill. Government should have waited for the
HMI Report and consider its findings and recommendations in the drafting of
both the NHI and MSA Bills, says Dr Archer.

“In my opinion, the process leading up to the implementation
of the NHI and the medical scheme amendments is going to be inevitably delayed because
the HMI recommendations and findings must surely be considered and incorporated
in the finalisation of the two bills,” Dr Archer noted.

The comment period on the HMI Provisional Report expires on
7 September, ten days before the close of the comment period on the two Bills
with the Health Market Inquiry expecting to release its final report only at
the end of November.  In a statement
earlier this month, Mark Arnold, Principal Officer of Resolution Health warned that
government’s insistence on rushing the two bills could conflict with the
insights the market inquiry gained through its work, resulting in the benefits
of this work being lost.

 “Closing the
submission period on the Medical Schemes Amendment Bill, which specifically
deals with the private healthcare sector, before the HMI’s final report is
available is analogous to putting the horse before the cart.  Such an approach squanders the opportunity to
strengthen legislation with the full benefit of wisdom garnered during the
lengthy and expensive inquiry and the best chance we have of making informed
decisions that will shape the future of healthcare in South Africa for all,”
Arnold commented.

At a recent closed discussion of the three documents by
various private healthcare stakeholders, participants agreed that the Bills
were poorly drafted and reflected poor policy, expressing doubt whether most of
the proposals will ever be implemented. According to a representative from the
medical scheme sector, the Bills are far less dramatic than the health minister
wants the public to believe and that fears around issues such as the NHI
replacing medical schemes, the abolishment of co-payments and forcing
healthcare providers to accept capped payments were displaced.

Dr Archer says while the SAPPF is opposed to the basic
tenants of the NHI, it does support the principle of universal healthcare from
a moral and logical point of view.

“We [private providers] will have to move in that direction
and improve access to the broader population that could be achieved with the
implementation of some of the HMI’s recommendations, which I believe will make
the private sector more accessible, affordable and transparent,” he says.