Prof van den Heever with IHRM director and seminar convenor, Irene Zambelis

The intention to withdraw the current medical schemes tax credits, as proposed in the recently presented NHI Bill, will represent “a huge risk” with implications for both the public and private sectors.

Making this point during Friday’s Institute of health Risk Managers (IHRM) Seminar in Johannesburg, Prof Alex van den Heever, Chair of Social Security Systems, Administration and Management Studies at the University of the Witwatersrand, reminded his audience about the group of people in the current medical scheme system who are income vulnerable: “Take away the tax credit and many people on fixed pension incomes and those with low incomes are likely to drop out of the medical scheme system.

“When this happens,” he warned, “we will have a sicker population going to public hospitals. These facilities, I believe – although I haven’t seen any details on this yet – will charge on the basis of a means test, a means test for access to a public service. This means that many of these people would then have to pay for services at a public hospital. Why?

“One would assume that the government would do the sensible thing to avoid this situation, that is take away the tax credit but make access to public hospital services absolutely free!”

Allied to this, Van den Heever noted, was a section in the NHI Bill which prohibits medical schemes from covering any condition NHI provides as a benefit: “Why put something in a Bill if it can’t be implemented?” he asked, alluding firstly to a recent media report in which NHI War Room head, Dr Olive Shisana, said that the cost of NHI would require an additional R33-billion a year by 2025/2026 over and above the R220-billion currently spent in the public sector.

“What she was saying was that, at an additional R33bn a year, the state would be able to buy a comprehensive pack for everybody that would allow them to prohibit medical schemes from covering the residual.”

Reminding his audience the state would already have more people on a service “which cannot accommodate the people already on it”, the R33bn, he said, would be a “drop in the ocean” in respect of meeting the additional demand.

Secondly, he added, there was “no way” any piece of legislation could be enforceable if the NHI cannot offer a reasonable package of care to someone who does not want it and would rather “spend their own money to buy somewhere else”.