The Health Funders Association (HFA), representing stakeholders in South Africa’s private healthcare funding sector, recently held a symposium to discuss the National Health Insurance (NHI) Act. The seminar focused on the changes the private health industry might face and their potential effects on the country, the health sector, and medical scheme members.
Dr Paula Armstrong, Senior Director at FTI Consulting, highlighted South Africa’s poor healthcare outcomes compared to countries with similar socioeconomic status, such as Lebanon, Tunisia, Egypt, and Colombia. She emphasised the correlation between socioeconomic status and health outcomes, noting that South Africans have higher levels of disability-adjusted life years (DALYs), indicating worse healthcare outcomes.
Armstrong cited data showing increased poverty levels post-2010 financial crisis and predicted a grim picture post-Covid. Over 50% of South African households are below the poverty line, exacerbating poor healthcare outcomes. She stressed the importance of universal health coverage in addressing these issues.
Need for a comprehensive approach to reform
Dr Simon Strachan, Chairperson of the South African Private Practitioners Forum (SAPPF), discussed the challenges and opportunities in South African healthcare. He emphasised the need for a comprehensive approach to reform, engaging healthcare professionals, and addressing social determinants of health. Strachan expressed concerns about the NHI Bill, including quality of care, access to healthcare, contracting with healthcare practitioners, treatment protocols, governance, medico-legal litigation, and corruption.
Strachan highlighted that improving primary healthcare services would increase secondary and tertiary care demand, creating a “hospicentric” system. He also noted the Act’s absence of provisions for physiotherapists, occupational therapists, and other rehabilitative facilities.
Negotiating the lowest possible prices for healthcare services could potentially compromise quality
The Act mandates that the fund reimburse accredited primary healthcare providers according to a prescribed capitation strategy, which Strachan argued may not be the best funding method. He raised concerns about the “Powers of Fund” section, which mandates negotiating the lowest possible prices for healthcare services, potentially compromising quality.
Strachan emphasised the importance of collaboration between the public and private sectors, with strong governance, adequate funding, and efficient administration, to achieve successful universal healthcare in South Africa.
He stressed the need for a well-governed, well-funded, and well-administered private sector working in parallel with the state for universal healthcare to succeed. In conclusion, the symposium highlighted the significant challenges and potential opportunities presented by the NHI Act, with stakeholders urging careful consideration of the Act’s implications to ensure the best outcomes for South Africa’s healthcare system.