Lawyers issue warnings about NHI scheme

Cape Town - Private medical aids and hospital groups should be cautious when offering services to government as part of the proposed national health insurance (NHI) scheme because there are still too many uncertainties surrounding the system, a lawyer has warned.

Neil Kirby, a director at Werksmans Attorneys, said that, while it was appreciated that the private sector was freely offering services and resources, this needed to be done with caution from a legal perspective.

“We are in unknown territory,” he said during a meeting at the Hospital Association of SA’s annual conference in Cape Town late last month.

The conference focused on the future of healthcare in the country and the role of the private sector at a time when government is preparing for the full implementation of the NHI scheme, which is supposed to ensure quality healthcare for all South Africans by 2026.

Kirby’s warning followed various suggestions by leaders in the private healthcare industry about possible cooperation between the public and private sectors regarding pregnancies, school healthcare programmes and cataract and hip replacement procedures, as prioritised in the white paper on the NHI.

Koert Pretorius, CEO of Mediclinic in southern Africa, said private hospitals could help with, for example, reducing the backlog of hip and knee replacements by doing a percentage of these procedures at lower tariffs, by acquiring pharmaceutical items and prostheses at state tender prices, and by using available capacity in private hospitals.

Private hospitals could help manage primary healthcare clinics near them, he added.

According to Richard Friedland, Netcare group CEO, South Africa can’t build a community and economy without proper access to quality healthcare for everyone.

The private sector is ready to work with the department of health to create a sustainable future, he said.

Netcare has been working with the UK’s National Health Service for the past 15 years to provide better healthcare for all citizens of that country.

One of the projects that demonstrate this successful partnership is the six mobile clinics that visit 30 different hospital parking lots in Britain over a five-year period to help tackle the backlog in cataract operations.

Britain’s state hospitals provide the parking lots for these units and access to electricity, said Friedland.

Private service providers have done more than 40 000 cataract operations.

What was initially an overnight procedure has now been refined to one that takes less than 15 minutes, and a single doctor can treat 24 patients a day. The service is offered six days a week for 50 weeks of the year.

Jonathan Broomberg, CEO of medical aid administrator Discovery Health, said a breakdown in trust between the private and public sectors in South Africa was hampering the establishment of universal healthcare.

He said leaders from both sides of the spectrum had to help repair this divide in trust so that a few “quick goals” that will benefit everyone in the country could be scored.

Broomberg said that, worldwide, there are various models – all of them unique to the country’s history and development – that will enable setting up universal healthcare.

“The lesson is that we have to design the reform path according our country’s needs. The time for talking is past. Implementation is now imperative.”

Kirby said there were at least 11 pieces of legislation and their accompanying regulations that would have to be changed before the NHI could be rolled out.

In addition, new legislation on the NHI fund (to determine, for example, who pays and what the money will be used for) and the NHI scheme (to deal with service delivery) is being contemplated.

Other uncertainties Kirby referred to included the future role of the statutory councils, the office of health standards compliance, the National Public Health Institute of SA, and the design of available benefits and interim structures that have to be finalised before NHI legislation can be considered.

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