As South Africa moves towards implementing the National Health Insurance (NHI), concerns are mounting over whether the new system will match the quality of care provided by private medical aids. Despite medical schemes’ standard coverage of essential services, experts highlight that NHI will require substantial funding to ensure that it offers comparable care, particularly in handling medical emergencies, maternity care, chronic conditions, and severe health issues.
Craig Comrie, Chair of the Health Funders Association (HFA), emphasised the critical role that medical schemes play in providing coverage under Prescribed Minimum Benefits (PMB) regulations. These benefits, which cover conditions ranging from cancer to strokes, are essential for over nine million South Africans.
Comrie points out that the private sector’s ability to provide these services remains invaluable, as it guarantees continuous coverage for essential services, regardless of a member’s monthly contributions. Comrie also noted the financial realities many medical scheme members face, with more than half having a monthly household income below R30,000. For these individuals, access to private hospitals for significant health events without coverage would likely result in substantial debt.
Additionally, an ageing population within medical schemes is leading to an increase in chronic conditions, which, coupled with a declining doctor-to-patient ratio, is driving up healthcare costs.
To address some of these challenges, the HFA actively engages with the Council for Medical Schemes to review PMBs every two years. This review aims to keep the benefits relevant to current medical needs and improve affordability for members.
Comrie acknowledged that while medical schemes strive to minimise contribution increases, members value the quality of treatment and ease of access to healthcare the most. He explained that the real value of medical schemes becomes apparent during critical times, such as when a family member is seriously injured in an accident.
He said hard-working South Africans deserve access to the best healthcare they can afford, and the current NHI model threatens to undermine this right. Comrie affirmed the industry’s commitment to collaborating with the government to develop workable solutions that will enhance equitable access to advanced medical treatments in the future. He also reassured medical scheme members that their benefits would not be immediately affected by the NHI Act, as full implementation of the NHI could still be decades away.
As the nation anticipates the rollout of NHI, the debate over funding and quality of care continues. The challenge remains: how will NHI provide the same healthcare access and quality as private medical schemes? The answer will depend on the significant financial investments and collaborative efforts needed to make NHI a success