Netcare CEO Dr Richard Friedland yesterday said private hospitals wished to work with government to find solutions to South Africa’s healthcare problems amid threats of litigation against the implementation of the National Health Insurance (NHI).
Speaking at the Hospital Association of South Africa (HASA) Conference in Sandton, Friedland proposed a mandatory medical cover for the formally employed as a potential solution that has been well-researched over two decades.
He said this was a “workable solution that, if implemented, will be quick to roll out and in a very short time provide enhanced healthcare to all South Africans”.
The proposed NHI is geared to create a universal healthcare system to ensure that all South Africans have access to affordable, quality healthcare services regardless of their socio-economic status.
The signing of the NHI Bill into law on May 15 by President Cyril Ramaphosa was a key milestone in the journey towards universal and comprehensive quality health coverage for all, but has been opposed by many as being financially unaffordable while there are not enough doctors and nurses to implement the NHI.
The NHI will be implemented in two phases, according to the Department of Health. Phase One has started and will continue for a period of three years until 2026. Phase Two will commence in 2026 and will run for a period of another three years until 2028.
The current national health system has a myriad challenges, among these being the worsening burden of disease due to people living longer and being more sedentary, resulting in a rise in non-communicable diseases such as cardiovascular diseases, diabetes, chronic respiratory conditions and cancer, as well as the scourge of HIV and tuberculosis, high maternal and child mortality, together with high levels of violence and injuries.
“Mandatory health cover of formally employed is tried and tested and if put to use in South Africa could reduce the public health burden, increase public per capita spend on health and free up resources that could help address the country’s most pressing health crises,” Friedland said.
He said the ANC’s 1994 Health Plan recommended mandatory cover for the formally employed and the Social Health Insurance Working Group in 1997 recommended that mandatory cover for formal sector employees should be confined to those above the income tax threshold, due to affordability concerns.
“With a formally employed population of 11.5 million, together with the estimated number of dependants, based on a 2.4 beneficiary ratio, this could result in up to 27.5 million of our population that could potentially over time become covered, leaving the remaining 35.5 (56% of the population) people dependent on public health resources,” Friedland said.
Government public health per capita spend, he said, could increase over time by 52% without any additional funding of the public sector budget.
“In simple terms, if one considered the entire population in South Africa, government’s responsibility would reduce from the current 85% of the population covered by public health to 56%,” he said.
The latest per capita public expenditure based on a consolidated health budget of R271 billion works out to R5 054, when considering the population and excluding medical scheme users.
With formal employment coverage, that per capita public expenditure on public health users would increase 52% to R7 659.
The HASA proposal would be implemented in three phases.
Phase One would involve including the formally employed and their dependants who are above the tax threshold. This would grow the medical scheme coverage from 9.2 to 15.4 million.
Phase Two would include those formally employed and dependants who are below the tax threshold. This would push medical scheme coverage to 27.5 million and expand public per capita spend to 52%.
Phase Three will allow for the expansion of the economy through recovery and an increase in employment.
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