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With the imminent publication of the White Paper on National Health Insurance, the question being asked by many delegates at the Board of Healthcare Funders’ 14th annual conference is “will it be constitutional?”
At the meeting, which took place in Cape Town this week, PhD student from Wits University Paul Wayburne, presented his opinion on how the rights of 8.5 million medical scheme members can be balanced with the rest of the population.
In his opinion, the constitutionality of the NHI has not been adequately researched.
“The Bill of Rights, the cornerstone of our democracy, affirms the right to healthcare for all people in our country,” he said. “The Bill of Rights is not dependent on residency, so does that mean that NHI will also provide for unregistered refugees and illegal migrants? This is something that will have to be clarified.”
Deputy Minister of Health, Gwen Ramokgopa who spoke later in the programme, allayed some of the delegates’ concerns when she confirmed that the delays to the issuing of the White Paper were “necessary so that we could engage with the substantial inputs from stakeholders. The White Paper will be the response that clarifies all the concerns that people may have”.
The comprehensive services envisaged in the NHI are expected by many in the industry to result in a reduced demand for membership of medical schemes, but the Deputy Minister said that medical schemes “will be with us for a while” and reassured delegates that her department would act responsibly in relation to medical scheme members.
“No one will be allowed to opt out of liability to contribute to the NHI, but that does not mean that people will be prevented from purchasing products and services. We do not envisage that the NHI will pay for cosmetic surgery, for example,” she said.
Wayburne commented that under Section 27 of the Constitution, the state must take “reasonable legislative and other measures within its available resources to provide healthcare for all”.
“In terms of decisions already made by the Constitutional Court, it is clear that the emphasis is on an egalitarian approach which allows for different services to be provided to different people in order to achieve an substantively equitable system.
“What this means is that it is not unconstitutional to treat people differently so that they can be given the opportunity to access healthcare. This could take the form of transport provision for people in rural areas, for example, and not for people in urban areas who may have easy access to healthcare facilities,” he said.
“Medical scheme members have the constitutional right to not be deprived of existing access to care,” he said. “The care has to reach a certain level of adequacy, which will be judged by the court on a case by case basis. They have a right to pay for additional care, however, the do not have the right to not pay for NHI.”
