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Discovery Health response to NHI Bill

Received via email, 12/08/2019

Publication of NHI Bill to Parliament

Discovery Health welcomes the publication of the NHI Bill as this provides more clarity on the implementation of the policy objective of Universal Health Coverage and the establishment of the NHI Fund.

We support the drive towards ensuring that all South Africans have access to quality health services based on need rather than affordability and we welcome the Minister’s collaborative approach in working towards this objective.

We believe that the publication of the NHI Bill creates a very important opportunity for active collaboration between the Department of Health and the private healthcare sector, to ensure that the expertise, skills and experience available in the private healthcare system are maximally leveraged to ensure the success of the NHI roll out.

The Bill is very detailed and we are working through the Bill before we comment in more detail on key aspects of the Bill. Our high-level view is that the Bill presents a workable framework and that an incremental implementation strategy is appropriate as this will ensure that feasibility and affordability are balanced with making progress towards UHC.

It is important that the initial focus is on priority projects where there are vulnerable groups in dire need of improved access to care such as the areas of cancer treatment and mental health. We also support the focus on primary and preventative care as the foundation of UHC.

In terms of the future role of medical schemes, we are studying the details of the Bill as these are not entirely clear, and we will engage with the Minister of Health and the NDOH in order to understand the implications of the Bill before commenting in detail.

Some of the lack of clarity arises from the language of the Bill. For example, Clause 33 notes that Schemes will be limited to complementary cover for services not reimbursable by the NHI. At the same time, Clause 8 of the NHI Bill states that the NHI will not reimburse for services when a citizen does not follow the referral pathways. Together, these could be interpreted to mean that medical schemes could provide cover for any service that is not funded by the NHI if you don’t follow the pathways. A simple example might be out of hospital and in-hospital maternity care services. In this example, the NHI would not reimburse for these services where a patient does not follow its specified referral pathways starting from the primary care site. In this situation, it appears that a medical scheme would be able to cover the maternity services for members who choose not to follow the specified NHI referral pathways.

Discovery firmly believes that once South Africans have contributed to the NHI, they should be free to decide whether or not to follow the NHI referral pathways and to use the NHI services, and that citizens should have the freedom to purchase health insurance to cover any services including those provided by the NHI should they wish to do so. This is the situation in virtually every country in the world which has some form of universal health coverage - in these countries, citizens are obligated to contribute to the NHI or the equivalent public funding mechanism, but they are then entirely free to purchase private health insurance for any services, including those provided by the NHI, should they wish to do so.

We will be actively engaging the Minister of Health on this issue, and we look forward to working constructively with the Minister and the Department of Health to obtain clarity on various aspects of the NHI Bill and will work hard to contribute towards the successful implementation of the NHI system.

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