One of the setbacks with a single payer system is that takes way the diversity of alternatives in the event of inevitable failures, Hospital Association of SA’s Dr Dumisani Bomela pointed out during this week’s SAMED Conference “Unpacking the sustainability of National Health Insurance” session.

“A single funder and the complimentary role of schemes as proposed is a major issue that needs a rethink,” he added.

Two aspects of the proposed system that still had to be carefully considered, he noted, was the need to optimise funding and to optimise service provision.

“On the funding side, worsening constraints of our fiscal envelope will have a severe impact on a purely public funding system. An interactive, incremental approach is critically important to ensure that we live within our means. Fortunately the NHI Bill does open this avenue and we are grateful for this.

However, the single funder and complimentary role of schemes is a major issue that needs a rethink: “On the one hand,” Bomela explained, “we have constrained funding sources and on the other hand we are legislating to limit the inflow of private funding sources. We should be inviting all funding options to come in and invest responsibly and grow our country’s investment in health care.

“Limiting the funding envelope,” he warned, “could prove to be counter-productive.”

Another of his concerns was the belief that the NHI Fund could set prices too low: “While this is attractive in the short term it erodes supply over time, becomes unsustainable and corrupts system in that way.

Turning to his contention that the single payer system also takes away diversity of alternatives “when major system failures occur as they always do with everything, he explained: “Regarding the  contemplated complimentary role of medical schemes once NHI is fully implemented, we should worry about the motivations in favour of this if we have unintended consequences.”

He indicated that it would result in “an outright denial of healthcare” for many people in the event of the public funder, for some reason, being unable to provide funding for those items that are on its formulary.

On optimising service provision, Bomela stressed that instead of planning programmes to be implemented with NHI, these need to be tackled now. If not, he warned, the service delivery platform will be unresponsive to the needs of the population. Here he referred to four major areas: infrastructure, human resources, medical technology and consumables, and most important, operational processes: “Most important and with the most opportunities will be the process issue, operational, how the system gets to operate on the service delivery platform.

“For some reason this hasn’t been a focal area but is where the biggest areas for potential improvement lie,” said Bomela, stressing the importance of public and private sector collaboration in this regard.

“No public funder single payer system has achieved universal access, but the private sector has a role to close this gap. More realistically it can be purposed to play a significant role to relieve the burden on the public sector. It does play a major role in primary healthcare across the world.

“The private sector is ready…”