NHI benefits and implementation remain undiagnosed

Many questions still up in the air.
Minister of Health Zweli Mkhize says funding for the National Health Insurance is a work in progress. Image: Shutterstock

Hundreds of medical professionals who packed the lecture hall at the Cape Town International Convention Centre on Monday to hear the minister of health talk about the National Health Insurance (NHI) were left with more questions than answers.

Speaking at the Hospital Association of South Africa’s annual conference, health minister Zweli Mkhize waxed lyrical with several quotes from the father of the nation, Nelson Mandela, but didn’t bring any new information regarding implementation of the NHI to light.

Where will the money come from?

Mkhize did commit to a seven-year government plan to fill vacant posts and finance refurbishing and development of new infrastructure, in order to meet capacity requirements when the NHI is fully implemented.

“We will be introducing the changes gradually and intend to have full implementation by 2026. There has been a great deal of robust discourse in recent weeks. I want to clarify that the sources of funding will be varied,” he said.

Mkhize backtracked somewhat on the figure of R30 billion, which has been bandied about in relation to the NHI, saying that the Department of Health (DoH) is in continuous consultation with National Treasury. “It will be tabled at an appropriate time in a money bill by the minister of finance.

“The money bill will have exact amounts and this will come … but not at this time. There is some work being done around costing beyond the next five years, but this is a work in progress,” he said.

What services will the NHI provide?

Mkhize said challenges facing the public health sector include long queues, staff shortages, dilapidated infrastructure, inefficient management, corruption and drug shortages – but did not elaborate on how these issues would be addressed.

However, he went on to say that the NHI espoused the principle of social solidarity where “we share resources and cross-subsidise one another”.

“The package of health services offered under NHI will be tailored to what our available resources will be able to afford,” he said.

Under the NHI, patients will be required to register with their local doctor, clinic and pharmacy in order to facilitate swift processing of their claims. Deputy director-general for the NHI, Dr Anban Pillay, told the conference there would be a strong focus on primary care as the first point of reference.

This effectively means the NHI will not pay for a patient to go directly to a neurologist if they are suffering from chronic headaches – the patient would have to consult with their doctor (general practitioner) and be referred to a neurologist before any claim from the neurologist could be covered.

“The GP will become the gatekeeper,” Pillay explained.

He also noted that the package of services offered under the NHI might not necessarily be the same each year – bringing to mind a system similar to that of current medical aids, which change their benefit options on an annual basis. Pillay said the minister of health would announce each year what services would be covered under NHI and any remaining services could then be covered by medical aid schemes.

Sharing of information between public and private sector

Mkhize said the DoH would be looking at initiatives such as a central chronic medicine dispensary and delivery system and introducing concepts such as ATM medicine dispensaries. In response to a question from the audience, Pillay conceded that the finer points around practical implementation of the NHI still needed to be ironed out.

“There would have to be some sharing of patient records when it comes to chronic medication to avoid patients having to go through the chronic medication approval process again,” he said.

Jonny Broomberg, chief executive of Discovery Health, the country’s biggest medical scheme, seemed upbeat about the introduction of the NHI, noting that “government should let the private sector in the door rather than trying to reinvent the wheel”.

Both Pillay and Broomberg reiterated that medical schemes would still have a role to play, by paying for any services not provided for under the NHI.

For example, Pillay clarified that if a patient chose to ignore the NHI provisions and directly consulted with a specialist doctor, this could then be claimed for from a medical aid scheme.



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Of course our Dr Broomberg is upbeat-but the term should rather be up the ANCs rear end. He is performing the role of a colonoscopy of the ANC with this NHI nonsense-and despite his upbeatness his companys share price-and thus the market-is somewhat less upbeat.

Corporate South Africa has to look in the mirror and ask whether honesty is still a value practiced by them particularly when commenting on controversial and incompetent ANC policies.

Now Dr Broomberg-please go disinfect yourself-you are covered in the brown stuff

I think Churchill said something like.

We either benefit unequally in the prosperity of capitalism or equally in the misery of socialism.

This (the NHI) may well prove to be S.A.’s biggest scam in future, even surpassing the Eskom scam.

This will be just to complicated and colossal in scale for government to handle, battling currently to make the education system work, NHI is a giant of wild horse.

Reading this you can almost imagine Discovery executives licking their lips every time Mkhize boasts how unprepared and clueless he and his department are on the implementation of NHI.

It will require bureaucracy on a scale never before seen and Discovery is positioning itself to be the major player.

Dr. Broomberg is not sharing the stage with the minister because of his angelic altruism. He became filthy rich as a result of the disease and misfortune of a few million medical aid members. He will become even more filthy rich as a result of the disease and misfortune of tens of millions of compulsory NHI members.

Compare this with good Dr. Surve, whose publications have been waxing lyrical about NHI for years. Ayo (funded by state pensions), as was heard during the PIC commission, also intends to provide NHI services.

Is there any difference between leeching by Discovery and Ayo? It seems to me that one is just better at hiding its trail of slime.

Agreed and there is a parallel here with how the ANC destroyed independent pharmacies to benefit Clicks and Dischem. Who got shares for free?

ANC Govt already owes private business R7Bn which it struggling to pay through incompetence and corruption, How do they ever think they will be able to admin the NHI. I cannot think that any firm will continue to supply the NHI because of government non payment of accounts.

Not sure our man here knows what is going on around him.

Did he not hear the Pres. say “our financial resources are depleted”? So why speak to treasury?

Does that not mean we have NO money?

They keep thinking that somehow they can continue taxing the middle class to bring them down to the level of the poorest of the poor and pay for it. Equality?

Its like saying “Let them eat cake”. We all know what the consequence of that was.

This is going to be a tipping point for many people. We pay tax for the (non-existent) police, additional money for private security companies and even more money for neighborhood security initiatives. Now we will have to pay tax for (non-existent) state healthcare, additional tax for NHI and on top of this even more money for private healthcare. There comes a point when you say enough and no more. That point will be reached with NHI. The unintended negative consequences of this well intended but insanely thought out project will be enormous for the country. Don’t say you weren’t warned ANC.

My fears as well. When the upper & upper-middle class (all of which are SA Taxpayers) has to stand in queues at private hospitals, threatening their health…they will be on the next Qantas (or BA) flight out of here.

The medical specialists will leave SA before most. But don’t worry, Saffas can easily use You Tube tutorials to operate on ourselves.

Both my GP and dentist are planning their escape soon. Both are flying BA…

I admire the idea of a higher quality of medical coverage for all.

However given the track record of the governing party, they have failed miserably in every aspect of Governance.

The only people who want this to be rolled out are those who will be able to milk the cow and they will milk it dry.

I might be a moron but I say go ahead.

As long as they IPTP (investigate, Plan, Test, Prove) on a small scale like a single town, once it is working and completely transparent then roll it out 1 town at a time.

Any other way and I agree with everyone else, it will be the biggest crime ever committed.

The diagnosis is pretty clear, it is fatal.

..exactly! It’s diagnosed as a malignant cancer on society….the patient will die painfully after 2026.

I’m all for free healthcare but this country simply cannot afford it with its ever-shrinking tax base. A country like the UK — with unemployment at around 3,8% — still struggles to keep its NHS running properly and properly staffed. How ON EARTH does the ANC expect this country to fund a similar system with 37% unemployment and a tax revenue shortfall of over R50 billion. Not to mention barely enough doctors and nurses to cater for a population that now includes God knows how many ‘imports’ from neighbouring countries. Idiocy of the highest order!

When this NHI thing happens the have and have not will share equality in misery.

As has been commented, it’s a “noble idea” (it works in 1st world countries where EVERYONE PAYS & everyone receives same benefits in return)

“In practice” in a 3rd world country…..you get a situation where a president like Robert Mugabe visits his healthcare practitioner in….where?…Singapore!

(…what Mugabe is implying “…to hell with Zimbabwe’s healthcare system! I support the best person for the job”).

It matters A LOT when your own fragile health is at stake, hey Pressie?

100% Michael and guess who is paying for Mugabe’s (and the ANC’s elites) visits to overseas doctors and hospitals. Well it is yours truly the SA taxpayer, exactly the same person who is expected to fund the NHI theft pit.

“A work in progress” is what the ANC calls its failures – like our democracy….

The whole idea of Communism (which our Govt still seems in love with despite it destroying over 50 countries) is a dog’s knackers. Can everyone afford a Mercedes Benz or Porsche? No, only those who are rich enough to pay for the privilege. Can anyone buy a house in Clifton? No, only those who have the cash. It’s the way the world works. Should everyone be able to enjoy the services of a top specialist who has expended a lot of money over at least 7 years to be able to practice. No, he only has limited work time every day. He CAN’T see everyone ‘because it is their right’. Communism, and its pink sister, Socialism, are pure BS here. As Thatcher said of Socialism, it works fine until you run out of other people’s money. And in SA there is VERY little ‘other people’s money'(i.e.tax) to spare. Can’t work.

End of comments.



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