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Proposed single-payer NHI system ‘will stifle innovation in health care’

Professor Monique Zaahl is the first black woman with her own private DNA lab, GENEdiagnostics, and is hoping to make gene testing affordable. Picture: David Ritchie, ANA

Professor Monique Zaahl is the first black woman with her own private DNA lab, GENEdiagnostics, and is hoping to make gene testing affordable. Picture: David Ritchie, ANA

Published Sep 14, 2021


RATHER than implementing National Health Insurance as a single-payer system, as is proposed in the NHI Bill of 2019, the government should consider using elements of the existing health system to provide quality health care to all South Africans, says the Health Funders Association (HFA).

The industry body representing medical aid schemes presented its position on the NHI Bill to the parliamentary portfolio committee on health last week.

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The HFA said it pledged support for universal health coverage for all South Africans and was committed to contributing constructively to strengthening and building a sustainable and integrated health system for the country.

The industry body, which represents half of medical scheme principal members, emphasised the urgency of achieving universal health coverage, given the country’s level of economic development, poor health outcomes relative to economic peers, and its complex and shifting burden of disease.

Lerato Mosiah, the chief executive, said that considering the fiscally constrained environment and the global recession brought about by the Covid-19 pandemic, an incremental approach to achieving sustainable universal health care provided a more manageable increase in expenditure over time, while balancing other national priorities.

She said the HFA was calling on the government to use the establishment of the NHI framework to put in place the reforms necessary for integrating medical schemes into the NHI rather than limiting their role, as that would adversely affect access and cost of cover.

“Restricting the role that medical schemes can play will place a greater burden on the public sector and mean a much narrower range of services than is currently provided by medical schemes. Curtailing the ability of medical schemes to pay for services creates significant uncertainty amongst service providers and may discourage them from practising in South Africa,” said Mosiah.

The association suggested that a single-payer system with sole buying power would not result in lower prices and might threaten the equilibrium of demand and supply of services.

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“A single-payer system disincentivises research and development, which often requires significant financial investment, and discourages investment and innovation in health-care provision,” Mosiah said. “A multipayer system, in which virtual risk pools are established by a risk adjustment mechanism, would be preferable, as it would avoid the pitfalls of a single-payer system.

“We believe that medical schemes have the necessary expertise and infrastructure to participate in achieving sustainable universal health care in South Africa and urge the government to make provision for this in its legislation,”she said.


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