Since President Cyril Ramaphosa publicly signed the National Health Insurance (NHI) Bill on May 15, there has been a huge outcry, threats of litigation and, unfortunately, a great deal of misinformation. Lee Callakoppen, Principal Officer of Bonitas Medical Fund, the second biggest private medical aid scheme in South Africa, says the Act is a complex piece of legislation that still needs to be clarified, along with new reforms and regulations that will need to be introduced, which could take years. His advice to private healthcare members: Remain calm, it is ‘business as usual.’

‘There has been a great deal of media attention around the signing of the NHI Bill and we have received many questions regarding whether private healthcare still exists,’ says Callakoppen. ‘It very much does. There is no need to panic, at this stage members of private medical schemes are unaffected. Access to affordable, quality healthcare services remains a priority and private medical schemes are still going to be providing healthcare and benefits to members as and when they need it.

‘The Bill proposes a phased-in approach and, as mentioned, this could take decades, so it would be irresponsible to cancel private medical aid membership now.

Phasing in of NHI

As we know, the NHI Bill has been signed, it has been gazetted and is now an Act. However, ahead of the actual implementation, there are a number of complex reforms and restructuring processes required. The President has stated that the Government is open to additional engagement and collaboration with various stakeholders – including business, labour, social partners and the healthcare sector.

The Government has also reiterated that implementation will be phased in. ‘There is no element that is going to happen overnight or be managed in haste. Our legal framework also allows for amendments to be made,’ says Presidential spokesperson, Vincent Magwenya.

Collaboration is key

‘We have always been supportive of access to universal healthcare,’ says Callakoppen. ‘However, we strongly believe public and private healthcare systems have a dual responsibility to deliver this. We acknowledge the gap that exists, especially in terms of infrastructure and believe we have a role to play in supporting the enhancement of public facilities and healthcare reform in general.

‘In fact, we have supported various public healthcare initiatives over the past years in partnership with Gift of the Givers. These have included providing access to water infrastructure to supply clean, running water at various public health facilities, hospital ward refurbishments, supplying medical bursaries and sponsoring an audiology programme, to name a few.

Our concerns

There remain concerns, mainly around funding, administration and continued freedom of choice as set out in the Bill of Rights.

Funding: Detail is lacking in terms of the funding of the NHI. The most likely option is additional taxes. However, until the NHI implementation plan is finalised, it is difficult to know what the actual costs will be. A fact though, which needs to be taken into account, is that taxpayers, including private medical scheme members, already fund 75% of the public health budget. 

Administration: The administration of the proposed central system of healthcare will need rigorous governance as existing medical aids are strictly regulated. NHI too, would be a not-for-profit organisation owned by its members. Private medical schemes are under strict scrutiny and undergo public audits as they are obligated to the members of the medical aid which is, in essence, a Trust Fund.

Bill of Rights: All international concepts of universal healthcare make provision for freedom of choice and we believe citizens should be open to purchasing healthcare should they have the means to.

The role of medical schemes

Currently, the medical schemes’ role, under the fully matured NHI, is that of complementary services cover. According to the White Paper, NHI will be rolled out in priority areas first – these include healthcare at schools, childhood cancer, women’s health (including pregnancy, cervical cancer and breast cancer), disability and rehabilitation services as well as hip, knee and cataract surgery for the elderly.

‘But what about the remainder of the population?’ asks Callakoppen. ‘Medical schemes offer a number of benefits that are immediately available to members. This allows them to access the care they need when they need it. If the NHI is to be rolled out to specific target groups first, what becomes of others in need? That’s why we believe public and private healthcare can and should coexist.’

The way forward

It’s imperative that measures are put in place to allow medical schemes to work in tandem with the NHI, so that duplication of costs is prevented. 

We have always been in support of universal healthcare and believe that it is in the interests of the greater good of everyone. We need to focus on public and private enterprise working together, strong leadership, accountability and dealing with social-economic issues as an integral part of the process.

We also believe that a citizen-centric, multi-funder, multi-provider system is the best way forward for universal healthcare to succeed in South Africa.

In conclusion Callakoppen says that Bonitas, as with other medical aid schemes, will continue to look at ways of providing members with access to affordable, quality healthcare as they have done for the past 40+ years.