Cape Town 26 August 2019. Panelists from the HASA 2019 Conference at the CTICC. Picture Jeffrey Abrahams

If government wants private stakeholders to accept its NHI plans as set out in the recently released NHI Bill and collaborate with it to ensure successful implementation, it will have to address the ambiguities and contradictions in the draft legislation. This was one of the main messages coming out of a panel discussion at this week’s Hospital Association of SA (HASA) Conference in Cape Town. Led by former BUSA Chair, Tanya Cohen and consisting of representatives of various sectors in private healthcare, the panel had the opportunity to state their position on the draft Bill and question Dr Anban Pillay, Deputy Director General of the National Department of Health, on issues that require more clarity and which could potentially lead to the NHI not achieving its very ambitious objectives.

While Dr Pillay should be lauded for his willingness and transparency in responding to the questions and issues raised, it was clear that government was still somewhat clueless on certain aspects of its own plan and was making it up along the way as more and more serious questions are being asked.

Huge cost of uncertainty

Head of the Pharmaceutical Task Team and Aspen executive, Stavros Nicolaou pointed out that the uncertainty and confusion that followed the release of the Bill had severely a severe impact on markets, wiping off a total of around R65 billion of the market value of private healthcare companies listed on the JSE such as Discovery, drug companies and private hospital groups. This he added, also affected pension funds as the PIC is a big investor in the healthcare industry.

Nicolaou appealed to stakeholders to stop the emotional outpourings and rather work together to find common solutions that will not sink the private sector but provide healthcare equality as envisioned through a universal health coverage system.

Discovery Health CEO, Dr Jonny Broomberg, said while he didn’t agree with those who are attacking the NHI “root and branch” and calling it “a catastrophe and not workable” , clarity on the role of medical schemes and what they can and can’t cover when the NHI is finally implemented is needed urgently.

“On one hand Section 33 of the Bill states that medical schemes will be limited to covering only services that are not covered and reimbursable by the NHI Fund. However, in Section 8, it says that a patients can also claim from medical schemes if they don’t want to go the referral route, (where they can only access the services of a specialist if referred by a primary health provider) or who prefer to use the services of a provider not accredited with the Fund, “ Dr Broomberg noted.

Dr Pillay said that if the NHI did not pay for a procedure or consultation, a patient may self-fund or go to an alternative private funder. Dr Broomberg interpreted this as meaning that if a woman was pregnant and needed ante-natal-care and elected not to use the NHI, a medical scheme could fund her. “It’s a major relief for us,” he said, emphasising that Discovery Health was fully behind the intentions of the NHI and fully supported expanding healthcare equity.

Unpacking the Bill before the panel debate, Dr Pillay, said that between now and the full implementation of the NHI in an expected six years’ time, medical schemes would continue to exist in their current form. The full package of services as defined by the incumbent Health Minister would not be the same “in year three, five or seven – it will be constantly evolving,” he said.

Exemption from Competition Act

Tanya Cohen referred to the reference in the Bill that the Fund will be excluded from the Competition Act to allow it to negotiate with providers on price and the cost of the delivery of services. According to Cohen, this provision could be potentially challenged as the consequences off replacing competition with a single pricing formula could impact on health providers willingness to provide efficient services as it will effectively take away their ability to compete on the basis of delivering the best service at the lowest price. She said she didn’t understand this provision in the Bill in the light of the work of the Health Market Inquiry that will only release its final report at the end of next month.

Timeous payment

Asked about the timeous payment of providers and suppliers, Dr Pillay said an administration structure similar to that of medical schemes will be set up within the Fund to ensure that providers are paid on time and that there are no outstanding bills.

Dr Broomberg urged government not to try and reinvent the wheel with the NHI but to learn from the procurement experts in the private sector.

“Our concern is policy makers saying we will do it ourselves and that there is no intention to outsource. I think the private sector should be pulled in to help as we have assets, skills and experience, Broomberg said.

GEMS Principal Officer, Dr Guni Goolab said that the Health Market Inquiry outlined a number of steps towards reforming the private sector. Dealing with care co-ordination and a basic benefit package properly could release billions of rands into the health economy – if handled correctly. No other sector could generate employment at both ends of the value chain, from palliative or frail care to skilled specialists, technology and research, he added.

SAMED Board Member, Dr Terrence Moodley said the ‘elephant in the room,” was the opportunity for fraud and corruption the NHI Bill could create. This issue was addressed earlier by the Minister of Health and Dr Pillay who emphasised that the NHI Fund will be a Section 3 entity that will be set up similar to the Medical Research Council which has very limited financial autonomy and is unable to take any financial risk as it will receive appropriations on a monthly basis from Treasury that will only be used for purchasing healthcare services.

Nicolaou said achieving a balance between sustaining private businesses and bridging the Gini-co-efficient was vital.

“Unless the private healthcare sector remained viable and sustainable, the broader economy would be badly impacted. This merely emphasised why a collaborative approach built on mutual trust was so essential,” he said.