The South African Medical Association (SAMA) says while some
of the proposals contained in the National Health Insurance (NHI) Bill are
reasonable, and keeping with the principles of the universal access to
healthcare, notably for the most vulnerable of the South African population,
many aspects are vague, and require more detailed clarification.

The Bill, along with the Medical Schemes Amendment Bill were
released by Dr Motsoaledi in Pretoria last week.

“There are aspects of this Bill, and the Medical Scheme
Amendment Bill, which we welcome. But there is too much detail which is
lacking. Sadly, given the enormous challenges with public sector healthcare
provision, any grandiose ideas for healthcare are not shared; our members would
simply ask for a functioning system first and foremost,” says Dr Mzukisi
Grootboom, chairperson of SAMA.

And, says Dr Grootboom, the Association questions the
practicality of the timelines for the implementation of the NHI as set out in
the proposed legislation.

“We would’ve hoped government would present a clear and
coherent plan for the revitalisation of the public healthcare system that is so
desperately needed. Government must also realise that the human resources we
have in our healthcare system – both public and private – are not a dispensable
commodity, as is unfortunately how they are sometimes perceived and dealt
with,” he notes in a statement.

SAMA has a number of major concerns in relation to the NHI
Amendment Bill. First amongst these is the fact that the intended right to
expand access to healthcare does specifically refer to access to high quality
healthcare. It is imperative that NHI must not result in quality of care lower
than that which medical scheme beneficiaries currently experience.

“Instead, NHI should seek to address the quality of care
currently not enjoyed by non-medical scheme beneficiaries. Currently, the state
has not proved it is competent to provide good quality of care, and there is no
certainty that the NHI Fund (the fund which will administer NHI) will be able
to contract services with private providers. This may necessitate duplicative
medical scheme cover to avoid violation of rights to quality healthcare,” says
Dr Grootboom.

He says other provisions, such as the fact that the Bill
encourages Doctors to provide services at the ‘lowest possible price’ can only
be accepted if these tariffs are reasonable and consistent with realistic costs
of service provision.

As for the Medical Schemes Amendment Bill, Dr Grootboom says
there are again issues that are positive but which require further

“For instance, we support the abolishment of brokers as they
have dismally failed to show their value in the private healthcare system and
this will also aid reducing non-healthcare costs. However, any money saved from
this must be used to expand health services. Doing one without the other is, in
our view, counter-productive,” he explains.

Dr Grootboom says a more thorough unpacking of the Bills has
commenced and that SAMA will continue to engage with both its members and the
government on the issues.

“At the basis of everything, though, must be an
understanding that medical professionals provide an essential service to our
country and their value cannot – and should not – be underestimated or
devalued. At the same time we will need to understand in greater detail exactly
how government plans to unpack this legislation, the time frames it intends
doing this in, and the impact all of this will have on healthcare provision,”
concludes Dr Grootboom.