A first step towards national health insurance in South Africa?

Healthcare pricing regulations passed quietly into law just before Christmas may have greater consequences than many healthcare industry players realise. They could be the precursor to compulsory national health insurance for all South Africans.

“While some industry observers may overlook the regulations as insignificant, I fear they are a symptom of something bigger,” says Neil Kirby, director of Healthcare, Pharmaceutical & Life Sciences Law at Werksmans Incorporating Jan S. de Villiers.

He says the healthcare pricing regulations passed on Christmas Eve 2008 contain a key stepping stone towards the implementation of a national health insurance system: a single, uniform pricing reference list for healthcare services.

“National health insurance invariably works off one pricing list for all healthcare services,” Kirby says. “The fact that we now have such a list, for the first time in South African law, may be the first step in government's plans to introduce a national health insurance system.”

He points out that national health insurance features prominently in the ruling party's election manifesto as a means of equalising access to affordable healthcare services.

“In light of this, it would be short-sighted to dismiss the new pricing list as insignificant simply because it is not mandatory at this point.”

According to Kirby, the new pricing list, determined by the Department of Health, indicates the prices that healthcare consumers should expect to pay for all health services across the healthcare professions. “Adhering to the prices listed is not apparently mandatory. However, if one is going to use a reference price list to benchmark or determine one's prices, then only one list may be used and that is the published list - therefore the list does operate in a mandatory manner.”

Of particular cause for concern is the timing of and manner in which the new pricing list was prepared and passed into law.

“Firstly, although the regulations were the subject of much debate between the Department of Health and the healthcare industry for much of 2008, the latter's input was not taken into account in the pricing list as published. Those prices were determined exclusively by the Department of Health, without any other substantive input,” he says.

Also raising question marks over the process followed was the timing of the passing of the regulations into law. “The list was initially supposed to have been finalised by September/October 2008 but nothing happened within the requisite time frames,” Kirby says.

“Then, out of the blue on 24 December 2008, at the height of the festive season, the dormant process was resurrected and a price list was suddenly passed into law. That is worrying and begs the question: Why was the pricing list published on Christmas Eve, at the 11th hour, with very little public input? Why the apparent subterfuge and what were the health authorities trying to avoid?”

Adding to the uncertainty is that the Department of Health has subsequently published a fresh request for comment on healthcare pricing and, on 6 February this year, held a briefing on the topic. “Unfortunately, it is not clear if they are planning to amend the existing list or are simply initiating the 2009 round of an annual process.”

Kirby warns that the price list process followed so far is questionable. “Legally speaking, there are question marks over the process that will continue to haunt it into the future.”