As healthcare practitioners and analysts continue to debate the pros and cons of the proposed National Health Insurance (NHI), there is still much confusion over what will happen to medical aids. The NHI envisages a system where there is universal, free healthcare for all, doing away with the two-tiered system: public and private healthcare sectors.
Last Thursday, health minister Aaron Motsoaledi announced that two bills had been gazetted that would ultimately give effect to the NHI: the NHI Bill and the Medical Schemes Amendment Bill.
Ultimately, government aims to implement the NHI by 2026, and these bills are supposed to provide the framework for this, along with a host of amendments to other pieces of legislation.
According to weekend reports, experts have warned that South Africa could lose many doctors if the NHI is implemented in its current form. Doctors have especially raised concerns about planned tariff caps that will not allow doctors to charge their own fees for services, and many doctors have threatened to simply boycott the NHI or challenge it in court, according to Rapport.
On Tuesday, the South African Society of Anaesthesiologists (SASA) also warned of a mass exodus of doctors if the NHI is implemented recklessly.
According to News24, Dr Lance Lasersohn, SASA's vice-president, said, "We need to ask ourselves how we are going to make NHI work, when we do not have people to ensure that access is better."
He reportedly said that as it stands, 60 percent of healthcare professionals in the public sector want to move to the private sector over better pay, better working conditions and better access to equipment. And according to a survey, a total of 482 people want to leave the practice "for various reasons, mostly uncertainty".
"We need time to develop the profession and deliver quality healthcare to the public," he reportedly said.
Adding to the problems facing the NHI is uncertainty over what will happen to private medical aid schemes. Motsoaledi said they will not disappear, but experts think they will not exist in their current form.
But in an interview with Health24, Professor Alex van den Heever from the Wits School of Governance said the NHI Bill is "obscure about whether people can buy cover outside of the national scheme, and refers to private cover that is 'complementary'."
He said that in Canada, the government had tried to prohibit people from having private healthcare, until this was contested in court and the government lost.
"Prohibition serves no public purpose or social benefit," he reportedly said.
He also raised concerns that the bill puts too much power in the minister's hands.
"It is not appropriate to put billions in the hands of one politician," he reportedly said.
The minister will be responsible for appointing most of those charged with implementing the NHI, it has been claimed.
Dr Katlego Mothudi, managing director of the Board of Healthcare Funders of Southern Africa, told Fin24 that medical aid schemes will still exist, but that they will be for additional medical needs not provided for by the NHI.
He told the publication that due to limited resources, government won't be able to provide all the services possible when it comes to comprehensive packages. Government is likely to provide basic packages like health promotion, preventative packages, school health and the screening of some cancers.
Senior Econex consultancy economist Dr Paula Armstrong told TimesLive that if the NHI pays for the health service, medical aid schemes won't be able to cover the same services, legally. Medical schemes would then be for "top up" or "complementary" procedures.
Van den Heever told TimesLive, "This is an absurd infringement on the right to healthcare, as it would force everyone to use a public health system [that] cannot be held to account for performance. I do not see this provision ever seeing the light of day, as no health system in the world takes away the right of people to select their own care with their own money."