Is the NHI Bill fit for purpose?

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This was highlighted by delegates who attended a recent NHI Bill dialogue hosted by the Board of Healthcare Funders (BHF).

“Within the context of South Africa, as the country continues with engagements and preparations for the next steps for the NHI, it’s crucial that the NHI Bill addresses these and other important aspects around healthcare fairness in the treatment of patients,” says Dr Yogan Pillay, country director South Africa at the Clinton Health Access Initiative (CHAI).

Utopian perspective

Vishal Brijlal, executive director of CHAI concurs.

“It should be a healthcare system that treats everyone fairly; one that provides access to specialists and healthcare professionals who are adequately trained and have all the resources that they need to do their work,” he says.

"This kind of utopian perspective is what the NHI needs to deliver, and the question on our minds is, will the NHI Bill give us that?” asks Brijlal.

Concerns around the NHI Bill

The National Health Insurance (NHI) Bill has sparked unprecedented interest, with the Parliamentary Portfolio Committee on Health receiving more than 100,000 submissions in response to the bill, demonstrating the enormity of the challenges ahead.

Brijlal’s concern, based on the inputs made to the Portfolio Committee of Health, is that the NHI Bill doesn’t seek to deliver all of that.

He noted that concerns raised in the inputs made to the Portfolio Committee of Health on the NHI Bill are not around the principles of universal health coverage.

“There needs to be transparency in the entire process, around how decisions are going to be made, because these are some of the challenges making people uncomfortable and anxious,” he says.

A standardised approach

In essence the question of whether the NHI Bill is fit for purpose is centred in the fact that people are uncomfortable about what is currently being proposed and those issues need to be resolved between government and parliament.

Dr Katlego Mothudi, managing director of the BHF, stressed that there needs to be a standardised approach to the use of technology models across the board, in the public and private sectors.

“The current challenge is that the approach being taken and proposed presents a fragmented approach to healthcare.

“There is fragmentation between schemes and administrators in the private and public sectors, across the board.

“A priority of the NHI Bill should be about outcomes monitoring and reporting, fairness, and resolving the fragmentation in the system. This is not a short-term policy, but a long-term policy of national importance,” he adds.

Corruption

He also emphasises the need to address corruption head on.

“We need to deal with corruption and inefficiencies, because corruption denies the health citizen appropriate healthcare resources,” says Mothudi.

Lancet Commission findings

The Lancet Commission on high quality health systems shows that that poor-quality health systems result in more than eight million deaths per year in low- and middle-income countries (LMIC), leading to economic welfare losses of $6tn.

The research found that approximately one third of patients in LMIC experience disrespectful care, short consultations, poor communication, and long wait times.

Furthermore, the research found that less than a quarter of the people in LMIC believe that their health systems work well, compared to half of the people in high-income countries believing that they do.