Chantelle Benjamin
3 August 2009
Johannesburg — MEDICAL aid schemes’ proposal to work with the government on a national health insurance (NHI) system, rather than operate independently, has been welcomed by economists and health professionals as it could make medical aid more affordable.
It would also mean the survival of most medical aids themselves and prevent job losses in the sector.

But experts warn the public health system first requires a radical overhaul before any NHI system can be implemented, saying it is poorly managed and resourced and will not be up to scratch soon.

Economist Azar Jammine said hurried implementation of an NHI system in the current economic climate could mean “not only the loss of the public sector health system but the collapse of the … economy”.

The Board of Healthcare Funders (BHF), which represents most medical schemes in southern Africa, on Friday unveiled a proposal it intends making once the government calls for public comment on NHI.

The board suggests that medical schemes offer top-up cover for shortfalls in the NHI package. Medical scheme administrators could also collect patients’ contributions for NHI benefits from the central NHI agency, and pay service providers.

They said that medical schemes, in continuing services, would ensure a smooth transition for their 7-million users when moving into NHI.

The proposal would have the possible bonus of making medical aid cheaper for the man in the street, because members would only be paying for services not provided by the state.

Kurt Worrall Clare, CEO of the Hospital Association of SA, said any proposal by medical aids was premature until the government released a draft NHI document, but a private healthcare system remained vital .

“It’s all fine having a financial model but if the percentage of nurses to patients remains at 2,8 nurses to 10000 people, when the overseas average is 12 to 10000, then delivery will suffer.”

Jammine welcomed efforts by medical schemes to provide greater access to medical aid, saying he hoped such suggestions would “spawn a proposal that would see a more workable proposal than presently rumoured from government”.

He agreed that any system coming into effect had to include proper input from the private sector and an overhaul of the public health sector.

“Government keeps saying that the same amount of money is being spent on 7-million medical aid members as 40-million South Africans but the money in the public sector is being spent inefficiently — management and policies in this sector have been appalling and this has to be addressed.”

Jammine said the government’s funding of a national health plan could place serious strain on a system that is already spending on housing, infrastructure and electricity.
“Early implementation could … mean the death of not just private healthcare but the entire economy as the costs will be so exorbitant.”

Malcolm Kahn, chairman of Fedhealth, said: “The process needs to be phased in over several years with key issues the substantial upgrading of public sector hospitals, the training of more doctors, nurses and … staff, and exploring new avenues of funding.”