23 October 2009

Schemes back NHI for wrong reasons

The Board of Healthcare Funders has accepted a proposal concerning the role medical schemes could play under the controversial National Health Insurance.

The Board of Healthcare Funders (BHF), representing 95% of medical schemes in Southern Africa, has accepted a proposal concerning the role medical schemes could play under the controversial National Health Insurance (NHI), possibly without consultation or the backing of the majority of beneficiaries, reckons an analyst.

According to independent health economist Alex van den Heever, the BHF does not represent either members, employers, or the industry. Nor does it have the backing of Discovery (JSE: DSY), which has more than three million beneficiaries. Its proposals also make little technical sense as it appears to be premised on the faulty logic of the underlying ANC proposals.

"The proposals do not reflect the position of the majority of beneficiaries," said Van den Heever.

Further "it is not entirely clear that the BHF have an informed grasp of the proposals," says Van den Heever.

Van den Heever argues these proposals are not neutral of vested interests. "The fact that Debbie Pearmain from the BHF was responsible for drafting legislation for the ANC task groups raises many concerns about the interests underpinning the ANC's NHI proposals," reckons Van den Heever.

"In particular, the thinly disguised attempts to motivate substantial deregulation of medical schemes, this would be great for certain industry players, but very bad for member's rights," believes Van den Heever.

Heidi Kruger, spokesperson for the BHF, plays down Van den Heever.

She says this is "absolute nonsense" because no one knows the political stance of the board members, because this is not public information. Therefore there is just no way to ascertain this.

Multi-payer system
Kruger reckons the ruling party has not yet revealed how the policy will work, it has only given a broad structure stating that there will be an ear-mark tax of 3% to 5% of workers payroll. Employed people would contribute to the fund through their income tax, while the unemployed would make the contribution through VAT.

The structure also states there will be a single-purchaser (NHI Agency). Since the government is resolute about the implementation of the NHI, and the BHF members support the notion of universal access to health, the BHF has drafted a proposal to ensure that medical schemes continue to exist under the NHI and have a vital role to play. Among other things, the BHF has included a multi-payer system representing the medical schemes. The BHF proposal is aimed at playing a constructive role at the level of discussions at how the NHI will be rolled out.

According to Deputy Health Minister Molefi Sefularo, the NHI documents are not ready for release or debate. He has urged the private health sector to continue to plan, discuss and propose recommendations that will make the intellectual, financial and technical resources available to government in order to take the NHI forward.

Dr Humphrey Zokufa, the BHF's managing director, said there's no doubt that the NHI will be a South African reality with structural legislation coming into effect in the next few years. "It's a plan that will no doubt be rolled out in phases – there's a lot of work to be done."

BHF will be adding details to its NHI proposal with a focus on a more holistic health sector approach. The funders are centrally placed between government and providers; hence it will work more closely with healthcare providers towards attaining a model in which the private sector plays an integral role under NHI. "Everyone agrees, we've got one shot at implementing NHI – we better get it right," says Zokufa.

(Khosie Tom, MoneyWeb, September 2009)


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