25 August 2019

Provinces ask for caution on NHI reforms

Business Day 22 August 2019 - Huge restructuring will be required for an entirely new health-system architecture

The Budget Council — a statutory body composed of the national government and the nine provincial finance MECs — has flagged the complexity of implementing the National Health Insurance (NHI) scheme because of the implications for provincial health departments. In a statement after its two-day meeting this week, the council said: “While broadly supporting the objective of universal health care, the Budget Council considered that due to the substantial effect on intergovernmental fiscal relations, any implementation should be done in a phased manner and that provinces should remain engaged with the processes about the bill.”

Public urged to engage with NHI Bill

BizCommunity 22 August 2019 - Cabinet has called on members of the public to engage the National Health Insurance (NHI) Bill, which is currently before Parliament.

“Once it is passed into law, the Bill will give effect to universal access to healthcare to all citizens in our country, irrespective of their socio-economic background. This right is enshrined in the Constitution of the Republic of South Africa,” Minister in the Presidency, Jackson Mthembu said. Under the Bill, medical aid schemes will gradually be phased out until they, as the main source of primary healthcare, ultimately cease to exist.

No mandatory requirement for South Africans to join NHI

BizCommunity 21 August 2019 - The publication of the National Health Insurance Bill has resulted in much public comment as to the future of healthcare in South Africa.

The question that must be asked is whether or not all South Africans are compelled to become members of the fund as it is proposed in the NHI Bill? There are also important implications for purposes of applying the Bill of Rights to the fund, more particularly, the provisions of section 18 of the Constitution of the Republic of South Africa which provides that "everyone has the right to freedom of association."

Medical scheme administrators overstepping the mark in fraud investigations

Business Day 21 August 2019 - While fraud is a major concern for medical schemes, they are straying into the terrain of regulatory authorities, say some

Medical scheme administrators are overstepping the mark in their fraud investigations into healthcare professionals, straying into the terrain of regulatory authorities and claiming back money they have not proved they are entitled to, according to consultancy firm Elsabé Klinck & Associates. Klinck said there are different views on the application of section 59 (3) of the Medical Schemes Act. Klinck said many medical scheme administrators claw back funds in cases of suspected fraud without substantive evidence, but in her firm’s view there has to be proof of fraud before money is reclaimed. The principles of administrative justice and the principles relating to the law of evidence must be applied, she said.

SAPPF: Evidence of ‘harassment’ of doctors but not racial profiling

Medical Brief 21 August 2019 - The SA Private Practitioners Forum says it has no evidence medical schemes are using racial profiling to determine which of its members to investigate for fraud

The SAPPF said the medical schemes coding system used in the country was at the centre of what appeared to be harassment of health practitioners. According to an Eyewitness News report, Kok said doctors outside cities suffered the most because the schemes didn’t understand the conditions under which they operated.

Waiting times for cancer treatment worsen at Charlotte Maxeke

Medical Brief 21 August 2019 - Waiting times for cancer treatment at the Charlotte Maxeke Johannesburg Hospital have worsened over the last year.

The delays have worsened particularly for 400 prostate cancer patients who will wait as long as three years for treatment. “Last year, the hospital’s CEO Gladys Bogoshi said that there were 300 prostate cancer patients who would wait two years for treatment, now it’s 400 prostate patients waiting for three years.

NHI Bill continues to spark furious debate

Medical Brief 21 August 2019 - The battle lines are drawn between the naysayers and supporters of National Health Insurance after the Bill was introduced to Parliament

Expert opinion on the NHI Bill before Parliament is divided between those who are wholeheartedly in support and others who are adopting a wait-and-see attitude, says a Cape Argus report. Implementing the NHI may fulfil the government’s constitutional obligation to provide quality universal healthcare for all, but the system has caused debate, with people arguing both for and against it ever since the idea was mooted.

Medical aid non-disclosures: What you need to know

BizCommunity 21 August 2019 – Issued by Bonitas - The consequences of non-disclosure can be devastating, from the costly repayment of claims to having your membership terminated.

Non-disclosure in terms of medical aid means that the member has not disclosed all the medical information when applying for membership. Regardless of whether it was intentional or not, a medical scheme has risk management mechanisms in place for detecting non-closure and, if discovered, the member will be penalised in some form. 

NHI is about fairer access and better use of resources

Business Day 20 August 2019 – Private medical schemes in SA accumulate most of the money in the country’s health sector but serve only about 16% of the population by Olive Shisana

On one level, universal health coverage is an aspiration — that all people can get the services they need, of good quality, without fear of financial hardship. That “achievement” is just an aspiration because every country, no matter how rich, does not provide everything for everyone. …. Finally, it is important to be clear on ends and means. Universal health coverage is a set of goals and therefore an “end” of health policy. It is not something to implement. The NHI or any other scheme or set of reforms are “means”, and the design and implementation (including adjustments needed over time) should be guided by their impacts on the universal health coverage goals (and intermediate objectives that influence them).

Reaction to the NHI is ill-informed: A constructive discussion is needed

BizCommunity 20 August 2019 – By Brian Ruff - The challenge for all stakeholders is how best to transition to this model.

Our debates should centre how to create a transition that is compelling and safe for those clinicians and hospitals that embrace the accountability model. We need realistic milestones and a strategy that poses no threat to their income.

No mandatory requirement for South Africans to join NHI fund as currently proposed

Business Day 20 August 2019 – The publication of the National Health Insurance Bill has resulted in much public comment as to the future of health care in SA. By Neil Kirby

The bill proposes a fund to purchase health-care services on behalf of those eligible to join the fund. The question that must be asked is whether or not all South Africans are compelled to become members of the fund as it is proposed in the bill? On the face of the bill as currently proposed, there is no mandatory requirement for South Africans to join the fund. 

Publication date: 8/25/2019