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2020/01/162020/01/20 09:01 AM
Medical Brief

SA‘s Health Minister Dr Zweli Mkhize says the National Health Insurance programme “will be run with the same efficiency and integrity” as the Road Accident Fund and the National Student Financial Aid Scheme, writes MedicalBrief.

Pam Saxby writes on the Legalbrief Policywatch site that since existing Public Finance Management Act section 3(A) entities have “set a precedent of good governance and accountability”, there is apparently every reason to believe that the funding mechanism proposed in the 2019 National Health Insurance Bill will follow suit, according to a media statement from the Health Department. Prompted by concerns about “media reports in which various stakeholders have made public comments … (on) the … Bill”, among other things the statement notes the “high index of confidence” in existing section 3A entities, which over the years have apparently ‘set a precedent of good governance and accountability’.
2020/01/152020/01/20 09:03 AM
Medical Brief

The out-of-the blue decision to end private-sector primary healthcare cover in March 2021 was “a brutal violation” of constitutional rights and, should medical insurers attempts to engage with the Council for Medical Schemes (CMS) be ignored, legal challenges are likely to follow, writes MedicalBrief.

The “shambolic” CMS move is “a continuation of the slow and steady poisoning of the private healthcare sector … and the governments dogged determination to dismantle [it] in preparation for its flawed and ideological desire to introduce its centrally controlled and administered National Health Insurance (NHI) scheme, says the Free Market Foundation. It is “without doubt, a violation of Section 27 of the Bill of Rights”.

Business Day reports that the CMS decision, made late last year and affecting half a million people, comes at a time when there are few viable alternatives in place as National Health Insurance is still many years away from offering primary healthcare cover, and medical schemes remain unaffordable and obliged to offer expensive hospital cover. At the same time, the CMS announced it will not grant insurers any more exemptions from the Medical Schemes Act.

Business Day reports that insurers were caught unawares and accuse the council of failing to consult them on its decision to scrap these policies and would possibly challenge the decision legally. Dr Ryan Noach, CEO of Discovery Health, says that, together with relevant industry bodies, it will urgently engage with the CMS, the Health Department and the National Treasury. Vernon Chorn, CEO of Unity Health, says it has taken legal opinion and has reached out to the CMS. It is considering an appeal against the registrar’s decision, which he says fails to appreciate the savings insurers create for consumers. Richard Blackman, CEO of Day1 Health, says closing primary healthcare products in the absence of a viable alternative will be “a brutal violation” of the constitutional right to access healthcare services.

Defending its decision to close the primary healthcare plans, the council is quoted in the Business Day report as saying its research shows that most insurers only pay out between 35% and 60% of premiums as healthcare benefits, unlike most medical schemes which pay out more than 90% of contributions as claims. Most of the insurers are spending close to half of premiums on non-healthcare related expenses such as administration and broker commission, while most medical schemes spend closer to 8.4%, the council found. But Chorn says the council’s report on insurance products is biased and fails to recognise that primary healthcare products are more expensive to administer than similar-sized hospital plans as there are 10 to 30 times as many claims for day-to-day expenses.

In an editorial over the festive season, Business Day described the “stunning” CMS decision as a “cavalier move” by an entity that appeared to have gone “rogue”. CMS registrar Sipho Kabane’s reasons behind the move were “muddled to say the least”

“The news that all but three of the CMS’s 11 senior managers will be out the door by April only adds to the sense of unease that has permeated the industry… There has long been talk that government players will do nothing to support the private health-care industry and the patients who use it, because a troubled sector makes the case for NHI stronger. Kabane is only adding fuel to that fire. He purports to be acting to protect consumers, but his latest moves will only hurt them.”
2020/01/142020/01/20 08:54 AM
The Star - Page 6

Health Minister Zweli Mkhize has emphasised that the government will not allow graft to infiltrate the National Health Insurance (NHI) system.

“We are not going to allow corruption. We are going to fight it,” Mkhize said in a recent interview with eNCA.
2020/01/142020/01/20 09:04 AM

A new year brings higher prices and some big changes to South Africa’s medical aid schemes. We’ve broken down what the five biggest schemes in the country have on offer for 2020 – and how much they’re charging.

South Africa is home to 80 different medical aid schemes, with 4.02 million registered members, serving a total of 8.87 million beneficiaries
2020/01/132020/01/20 08:36 AM

Between President Cyril Ramaphosa’s ongoing new dawn and important healthcare reforms, 2020 will be a critically important year for healthcare in South Africa. Spotlight formulated eight questions to set out what is at stake.

1. How, if at all, will the design of NHI change in 2020?

Given the ANC’s commitment to National Health Insurance (NHI), it seems a done deal that the NHI Bill will complete its parliamentary journey and land on the president’s desk before the end of 2020. That will not mean any immediate changes in healthcare service delivery, since NHI is only set for full implementation by 2026. The bill that the president signs will, however, set the course for NHI for the next decade or more by committing the country to various specifics regarding its design.

One critical question for 2020 then is, how much, if at all, the design of NHI will change during the parliamentary process. When the department of health published an earlier version of the bill for public comment in 2018, most criticism of the bill was ignored when a slightly updated version was sent to Parliament in 2019.

Will the parliamentary consultation process be any different? Will members of Parliament seriously and meaningfully engage with questions regarding the details of how NHI will function and be governed and then change the bill as needed?

2. Will the government finally fix the regulation of private healthcare?

A landmark report published in September 2019 found that the government had failed in its duty to regulate the private healthcare sector. The final report of the Competition Commission’s Health Market Inquiry (HMI) found that this regulatory failure has resulted in a private healthcare market that is both inefficient and not competitive.

One obvious thing for the department of health to do is to revise the Medical Schemes Amendment Bill based on the findings of the HMI and then to submit this bill to Parliament (an earlier version of this bill was published for comment in 2018). Presumably, they would have started revising this bill as soon as the HMI report was released in September 2019 (we don’t know whether they have). It will obviously make sense for Parliament to consider the Medical Schemes Amendment Bill alongside the NHI Bill – although this is not the trajectory we are currently on.

3. Will there be any high-profile prosecutions for corruption in the public healthcare sector?

The Special Investigating Unit (SIU) is investigating alleged corruption at the Health Professions Council of SA (HPCSA), the National Health Laboratory Service, the South African Health Products Regulatory Authority and in various provincial health departments. While the Hawks and National Prosecuting Authority are also dealing with a few cases, it is at the SIU that the winds of the new dawn seem to blow most strongly.

And yet, more than two years after an SIU report (the report became public in June 2018, but was completed earlier), found graft worth R1.2-billion at the Gauteng Department of Health from 2006 to 2009, the key person fingered in the report, former Gauteng Health MEC Brian Hlongwa, has not yet been prosecuted.

It is true that in another case, the North West Head of Department, Thabo Lekalakala, has been charged with fraud, but his case is ongoing, and even if the case against him holds, it seems likely he was acting on orders from elsewhere when he approved payments to the Gupta-linked Mediosa. Mediosa (previously known as Cureva) supplied the North West Department of Health with mobile clinics and was allegedly irregularly paid R30-million upfront.

A few high-profile prosecutions in the healthcare sector will help restore some much-needed confidence in the state and be a shot in the arm for NHI.

4. Will our understanding of SA’s TB epidemic change significantly in 2020?

Despite tuberculosis (TB) being one of the top killers of people in South Africa, estimates for various key TB indicators in the country are not very reliable. This can, for example, be seen in the very wide confidence intervals around key TB indicators for South Africa in the WHO World TB Report.

In order to get more reliable information on the country’s TB epidemic, South Africa started a National Tuberculosis Prevalence Survey in 2017. The survey was set to be completed in 2018 and reported in 2019, but there were delays. In response to a parliamentary question, Minister Zweli Mkhize said in November 2019: “We have recently completed the first-ever national TB prevalence survey and the results are currently being verified by the World Health Organisation.”

Our guess is that the findings will be made public on World TB Day in March 2020, but given how much of a public health emergency TB still is in South Africa, earlier would obviously be better.

5. Will the department of health finally fix and integrate its medical records and unique patient identifier systems?

The department of health had by early 2019 enrolled more than 26-million people on its new Health Patient Registration System (HPRS) – a number that is no doubt much higher today. Yet, healthcare workers report that in many places, medical records in the public sector remain a mess. In some places, records are still paper-based. In much of the country, the laboratory database does not talk to the TB database – and in much of the country, neither of these databases are linked to the new HPRS numbers.

As a result, people’s full medical records are not always available when they move from one clinic to another – something that has obvious implications for the people involved, but is also something that makes it harder to measure the performance of our healthcare system (particularly regarding HIV treatment and retention in care).

Will 2020 be the year that the department of health finally integrates all these systems in a way that works for both patients and healthcare workers? We understand that very significant progress has been made in the Western Cape in this regard, but what that means for the rest of the country is not yet clear.

6. Will a serious and realistic plan emerge to train and retain healthcare workers?

One ongoing problem in our public healthcare sector is the relative shortage of healthcare workers. On the one hand, we need to train more healthcare workers, and on the other, we need to retain the healthcare workers we do have. Jobs in the private sector and in other countries are an attractive option for many of our doctors and nurses since both the pay and working conditions are often better.

There are also some indications that even more healthcare workers will leave because of NHI. While the predictions of a mass exodus should be taken with a pinch of salt, it is worrying that many healthcare workers appear to be negative about NHI. One of the lessons from the early days of the NHS in the UK was that an explicit attempt was made to keep doctors happy, by among others promising good salaries.

Either way, it seems clear that we need a clear and implementable national plan for the training, employment and retaining of healthcare workers. Our previous plan, the Human Resources for Health (HRH) Strategy for the Healthcare Sector 2012/2013 – 2016/2017, has not yet been replaced.

In November 2019, the National Department of Health reported to Parliament that a “new HRH Strategy is being developed” and that “it will provide guidance on the number of health workers required for effective service delivery in the public and private sectors, as well as strategies for dealing with key HRH challenges”.

Whether we will see this plan in 2020 and whether it will be ambitious and implementable enough to meet the huge need in our healthcare system remains to be seen.

7. Will SA get legal certainty and political direction on medico-legal cases?

At the provincial level, the public health system is buckling under escalating medico-legal costs. Between Mkhize, the courts and possibly even the legislature, addressing this trend to the benefit of both public healthcare users and state coffers will be a key focus in 2020.

Last year, the Auditor-General flagged medico-legal claims as an increasing risk. The audit report noted that over a third of the provincial health departments had claims for medical negligence that were more than 10% of each department’s total budget for the 2019/20 financial year. This means far less money is available to spend on other health priorities. By March 2018, medical negligence claims against provincial health departments totalled R80.4-billion.

Recently, however, a judgement in the Gauteng High Court found that instead of paying up, the Gauteng department of health can now institute payment-in-kind for future medical needs in proven medical negligence cases. The judge ruled that the common law should be developed to allow courts to consider an order of compensation in kind rather than lump sums in appropriate cases where medical negligence is proven. This follows public statements by the health minister, who in Parliament, punted legislative amendments as part of his grand plan to arrest escalating claims against provincial health departments.

Some in legal circles argue that a “payment-in-kind” system will condemn healthcare users to the very system and service that failed them in the first place.

Either way, the debate on how best to tackle the department’s medico-legal dilemma is set to rage on this year in the courts as well as in government.

8. Who will be the new director-general in the department of health and how will this appointment impact the department?

Dr Precious Matsoso’s resignation as Director General (DG) in the department of health came into effect on 1 November 2019, bringing to an end almost a decade of service mostly alongside the former minister of health Dr Aaron Motsoaledi. Dr Anban Pillay is acting DG pending a new appointment.

Spotlight understands that Sibongile Zungu, Mkhize’s ministerial advisor on NHI, is a front-runner for the position. She is a former head of the department of the KwaZulu-Natal department of health. She made headlines when she was embroiled in an extended court battle with former KZN premier Senzo Mchunu after he decided not to renew her contract as head of the department in 2015. The labour union Nehawu made allegations of mismanagement and corruption against her at the time – although none of these allegations was ever proven in court, as far as we can establish.

Either way, whoever he or she may be, the new DG will play a critical role in answering many of the questions we have listed above. It should, of course, go without saying that the new DG should be a good and principled manager who will not stand for any form of corruption and is truly committed to public service.

It is now almost two years since Cyril Ramaphosa became president of South Africa. For all the promising dust that has been kicked up, there is still very little to show for the new dawn when it comes to healthcare. Many questions about NHI and about accountability for corruption in the public healthcare sector remain unanswered. Maybe 2020 will be the year the dust settles and we see just how much has or has not changed.
2020/01/20 08:38 AM
Weekend Argus (Sunday) - Page 7
Sunday Independent - Page 7

The National Health Insurance is back on the agenda, with more public hearings to take place

This comes after ANC alliance partners Cosatu and the SACP backed the NHI yesterday.
2020/01/20 08:39 AM
City Press - Page 2
Rapport - Page 1

Health Minister Zweli Mkhize says he does not understand fearmongering when it comes to the National Health Insurance (NHI) system because it will be managed in the same way as institutions such as the Road Accident Fund (RAF) and the National Student Financial Fund (NSFAS).

This week, Mkhize went on the defence after City Press’ sister publication Rapport reported that opinion polls indicated that many doctors were threatening to leave the country if the NHI was implemented in its current form. City Press also reported on these polls in the January 5 edition.

2020/01/122020/01/20 09:02 AM

Die minister van gesondheid sê hy verstaan nie die “bangmaakpraatjies” oor die nasinale gesondheidsversekering (NGV) nie, want diit gaan bestuur word soos instelling soos die Padongelukkefonds en Nasionale Studentehulskema (NSFAS).

Dr. Zweli Mkhize, minister van gesondheid, het wal gegooi nadat Rapport berig het oor die jongste meninspelling waarin dokters dreig om te emigreer indien die NGV in sy huidige vorm ingestel word.
2020/01/092020/01/13 07:16 AM

Health minister Dr Zwelini Mkhize says that he understands the apprehension around the new National Health Insurance (NHI), but has reassured stakeholders that the system will be run with the same efficiency and integrity as other public entities.

Mkhize said in a statement this week, that the NHI Bill proposes a funding mechanism that will achieve Universal Health Coverage as a section 3(A) public entity.
2020/01/13 07:18 AM

About half a million South Africans are set to lose the cover they enjoy for primary Health care in private sector from March next year with few viable alternatives currently in place.

Many are also at risk of losing the subsidies employers pay to provide this cover unless an affordable option is developed in the next few months. If not, they will be forced to pay more out of pocket or use state facilities as National Health Insurance is still years away.
2020/01/092020/01/13 07:20 AM

According to the SA Medical Association (Sama), 38% of its doctors would emigrate if the National Health Insurance (NHI) was implemented.

Sama, which represents 17,000 doctors across the country, conducted the survey to find out what doctors thought about the NHI Bill.

The survey also revealed that 39% of doctors said they would not leave, 17% were unsure and 6% would emigrate for other reasons.

Speaking to Gushwell Brooks, South African Medical Association spokesperson Dr Mvuyisi Mzukwa says they are supporting the universal healthcare system.

There are a number of submissions we have made to the portfolio committee in Parliament and some of the issues we have raised the trust deficit.
— Dr Mvuyisi Mzukwa, Spokesperson - South African Medical Association

The trust between the government and the profession has gone down because of what is happening currently.
— Dr Mvuyisi Mzukwa, Spokesperson - South African Medical Association

Mzukwa says they are supporting the universal healthcare system and they are also engaging the government.

We are engaging government and we have said we want to work with government but please assist members on this issues and if you don't we have members as stated in our survey that they will consider leaving.
— Dr Mvuyisi Mzukwa, Spokesperson - South African Medical Association
2020/01/13 07:14 AM

If all goes according to plan and there’s agreement, the National Health Insurance (NHI) Bill may just be on President Cyril Ramaphosa’s desk to be signed into law by July or August this year.

When asked about the legislative process going forward, chair of the Portfolio Committee on Health , Dr Sibongiseni Dhlomo, told Spotlight the bill might be brought before Parliament by May or June to be debated and if there is agreement and it is passed, the bill could be forwarded to the president to be signed into law by July or August.

Dhlomo was speaking on the side lines of the public hearings on the NHI Bill in Port Elizabeth on Friday, November 29.

Forging ahead

The Eastern Cape leg of the public hearings was the last for 2019. The committee hopes to wrap up the hearings by February this year.

“We will hopefully finish the last province in the first week of February, go down to Parliament and then look into all the written submissions,” Dhlomo explained. “(We will look at) what people are saying, where they are wanting amendments; then look into it, bring it to the department to say this is what the people are saying about your Bill because it is your product. You want to make this into law but there are gaps. What is your view on that?”

Dhlomo did not rule out the possibility that the work of compiling the reports after the public hearings might be outsourced.

“There may as well be a possibility of a professional person to summarise all the submissions that are written to us,” he said.

The DA, however, made it clear that they would insist that MPs themselves scrutinise all public comments.

The DA also indicated that it will ask for another legal opinion once the bill is referred to the National Council of Provinces (NCOP) for concurrence. DA MP Siviwe Gwarube said in a statement the reason for this is that the NCOP, as a different House of Parliament, needs to satisfy itself of the constitutionality of the bill.

“We will specifically request that the provincial roles be defined explicitly. While the National Assembly could consider this Bill with vague provincial powers, we cannot afford to do so as the NCOP. We will then also ensure that a full public participation process is rolled out by the NCOP where the areas that were not visited by the National Assembly are covered by the NCOP.”

Poor turn-out

Meanwhile, during the public hearings in Nangoza Jebe Hall in New Brighton, fewer than 100 people showed up for the first of the public hearings in the Eastern Cape. This hall can accommodate more than 2 000 seats. The Nelson Mandela Bay Metropole has a population of more than 1,3 million.

The hearings are a continuation of the nationwide public participation process to ensure that the bill is strengthened and is reflective of the views of all South Africans.

In the absence of the then mayor, Mongameli Bobani, the mayoral committee member for health in the metro, Yolisa Pali, welcomed the portfolio committee to the metropole.

Only a handful of councillors were present. The head of the Eastern Cape health department, Dr Thobile Mbengashe, and provincial and national health department officials also attended the hearings.

And, while bad advertising of the hearings and Black Friday and the “capitalists who are derailing the process” were blamed for the poor turn-out, the residents went ahead and raised concerns and sought clarity on the bill.

Broad support

Overall there was broad support for the bill. However, there were a few reservations and concerns about the implementation thereof.

Celestine Booysen, a resident of Helenvale in the city’s northern areas, lamented the lack of a clinic in her ward, with its approximate 38 000 residents. There was an outcry from several residents of other wards, including Wells Estate with its population total of about 24 000 on the outskirts of Port Elizabeth, that the Bill should address the need for additional primary health care centres in different areas.

Residents also asked that the bill address the professional development of health personnel as well as the shortages of staff and medication. In addition, residents called for more clinics to operate for 24 hours a day.

Cosatu came out in support of the bill.

“It supports social justice and will ensure that all our people, black and white, rich and poor will be able to access services,” said the trade union’s Mkhawuleli Maleki.

The lobby group Afriforum, on the other hand, said it didn’t support the bill, calling it an impractical and unaffordable scheme that had “implications far beyond the health sector”.

Cost concerns

Residents opposed to the bill also argued that health care needed a hybrid solution where private and primary health care complement each other.

They added that the government should share exactly how much this health plan would cost the taxpayer. In the absence of this crucial information, it was impossible to support the NHI, some said.

A nursing sister, Ncikazi Tsotsi, said the bill would bring back solidarity and human dignity, regardless of financial status.

“We believe it will stop us being ripped off by medical aids. We urge the NHI committee to put more energy into the infrastructure of the current buildings. Buildings are falling apart,” she said. “Secondly, (there is the issue of) insourcing of security staff in our institutions.

Thirdly we need to capacitate staff and health workers in our institutions, more specifically on soft skills.” Tsotsi said staff needed ‘soft skills’, referring to interpersonal skills and not just degrees to do their job well.
2020/01/082020/01/13 07:27 AM

The medical profession is becoming more outspoken in its criticisms of the National Health Insurance Bill among growing concerns over large-scale emigration. The SA Medical Association says doctors “strongly oppose” the legislation in its current format, with almost 40% saying they would emigrate if it was implemented, while in a Professional Provident Society survey 72% of all professionals said they would leave if the NHI is implemented in its current form, Rapport reports. PPS conducted the survey among more than 3,300 members for its written parliamentary submissions on the NHI Bill.

PPS also isolated the responses of 2,905 medical professionals, noting that 58% of them were negative about the proposals. The biggest concerns were lack of capacity, infrastructure and fears about corruption.
2020/01/072020/01/13 07:19 AM

A growing number of doctors in South Africa object to the incoming National Health Insurance (NHI) system, with just under 40% planning to emigrate if a universal health-care system is implemented.

Speaking to the Cape Argus, the South African Medical Association (Sama) said the proposed changes found in the NHI bill could cause wide-scale harm to the delivery of health care if they are not managed properly, adding that the bill had been introduced at a time of deep public mistrust in the government.

Dhlomo said that although the bill was not fully understood, the committee was impressed by the knowledge South Africans had about aspects of it. He added that the burning issues raised were generally the same, having heard the concerns of residents in four provinces before embarking on the Eastern Cape leg.

According to him, people are concerned about the budgetary implications of the Bill. “Other people who do not necessarily agree with the bill are asking where the money is going to come from. Can the department indicate how they are going to fund this process? So there are those varied responses that we get,” Dhlomo explained.

According to him, the public participation process is not merely a box-ticking exercise to complete all the steps in the process.

“We are here to listen and write down. We are going to engage the department and they must indicate to us why there won’t be any change to what people are suggesting.”

Friday was the deadline for all written submissions on the bill after the Portfolio Committee extended the closing date.

More than 100 000 written submissions have already been received by Parliament.

The hearings in the Eastern Cape were conducted in Komani, Mthatha and King William’s Town. The committee was set to wrap up the hearings in King William’s Town.
2020/01/062020/01/13 07:15 AM

Health Minister Dr Zweli Mkhize has outlined his vision for turn-of-the-decade babies under the proposed National Health Insurance (NHI) during a visit to King Dinizulu Hospital’s post-natal ward, in KwaZulu-Natal and assured mothers of the new ease of obtaining their new-borns’ birth certificates.

Mkhize was accompanied by KwaZulu-Natal Premier Sihle Zikalala, acting provincial Health MEC Kwazi Mshengu and his department’s HOD Sandile Tshabalala.
2020/01/062020/01/13 07:28 AM

Medical schemes in South Africa are facing a watershed moment with the imminent threat to their future role and overall existence under the National Health Insurance (NHI). By contrast, the prospect of a new age of technology will drive competition, based on efficiencies, value and innovation for the benefit of patients.
The Health Market Inquiry’s recommendations will pave the way towards a patient-centred, value-based healthcare regime. Patients whose doctors are empowered with good quality information have better outcomes and unnecessary healthcare expenditure is reduced.
2020/01/13 07:26 AM

A total of 72 percent of professionals surveyed say they will pack their bags and go overseas if the National Health Insurance (NHI) scheme is implemented in its current form.

This is according to a study conducted by mutual financial services company PPS among 3 300 graduate professionals who are policyholders. PPS conducted the independent survey among doctors, dentists, attorneys, accountants and engineers. It included the results in its written Parliamentary submissions regarding the NHI Bill.
2019/12/02 09:39 AM

There are three major aspects of the NHI Bill that we think need to change. Let us know what you think and we will incorporate your views into our submission on NHI. Our link is at the bottom of this article.

National Health Insurance can be divisive, not just because of what it proposes to do but because of how it is often sold as an all-or-nothing issue — either you buy into NHI completely, or you want things to stay essentially the same.
2019/12/262019/12/02 08:56 AM

The DA on Monday said that after scrutinising the National Health Insurance (NHI) Bill it had identified areas it would use as the basis of opposition.

“We have, in fact, discovered 25 areas of this legislation that we will be opposing in Parliament when we start with clause-by-clause analysis,” said DA MP Siviwe Gwarube.

“These areas we believe are incorrect or inconsistent with the idea of achieving the universal healthcare.” The DA maintained that the bill spoke to the use of money, not quality and sustainability of healthcare.

It insisted that there had not been an overhaul of healthcare and that there was a lack of innovation, meaningful focus on preventative healthcare and growing distrust between the public health system and the private health industry, among other issues.

Gwarube noted that there were too many vague elements of the bill which indicated poor planning, and the bill’s funding was in question.

“We raise the issue of the fact that the Health minister and Finance minister seem to be at odds with how the bill will be funded.”

Her colleague, Lindy Wilson, said the party had long held that the clear erosion of the provincial powers in the bill went against the National Health Act and to an extent the provisions contained in Schedule 4 of the Constitution.

“This will be teased out and tested by our legal team when the time comes,” Wilson said.

She also said there were concerns about how foreign nationals were to be treated in the bill that went against Section 27 of the Constitution.

Wilson added that the public participation process was flawed and that the public were not properly informed about what the bill meant and contained.

Mbulelo Bara, DA MP serving on the National Council of Provinces (NCOP), said the party would ensure that the second parliamentary house followed its processes to ensure the bill met constitutional scrutiny.

“Gone are the days where the NCOP simply rubber stamps the decisions made by the National Assembly,” Bara said.

Gwarube said that the DA wanted each one of the submissions they collected to be considered along with others submitted directly to Parliament.
“One of the fights we are going to have and we are to mount in Parliament is each and every single submission, including those sent directly to Parliament, needs to be scrutinised by Parliament and by the (health portfolio) committee itself,” Gwarube said.

She also said the days in which the national legislature could simply outsource its responsibility to a third party were over.

“We as public representatives need to go through these submissions ourselves and we need to ensure that the views of South Africans are taken into consideration in passing of this bill.”
Health portfolio committee chairperson Sibongiseni Dhlomo referred questions to the parliamentary communications unit, which said he was locked up in a public hearing.
2019/12/232019/12/02 09:38 AM

Public interest law centre, Section 27, has outlined its three major concerns with South Africa’s incoming National Health Insurance.

Open for public comment until 29 November, the National Health Insurance Bill aims to provide universal access to quality health care services across the country.

However, the bill has courted controversy since its inception with concerns raised about how it will be funded, the quality of care, and the future of private medical aid schemes.
In an analysis, Section 27 says that there are currently three major aspects of the NHI Bill that need to change.

These include:

Governance – The Minister of Health appoints the NHI Fund Board members (after appointing the ad hoc panel that interviews and recommends them), the Board Chairperson, and the CEO of the NHI Fund. In simple terms, decision-making is far too concentrated;
Transparency – To increase public trust in the NHI and to reduce the risk of corruption under NHI, it is imperative that all NHI-related processes and decisions are as transparent as possible;

Try before you buy – The NHI Bill introduces a range of new structures and administrations that are untested. We are bringing the establishment of these new structures into law, with no way to turn back if they fail, and without any transition provisions that could stagger implementation and allow for learnings.

Healthcare workers not happy

A recent report by trade union Solidarity has also warned that the incoming National Health Insurance (NHI) will have an impact on the healthcare industry.

Nicolien Welthagen, a research psychologist at the Solidarity Research Institute, said that the report is based on questionnaires sent to healthcare practitioners in the private as well as the public sector across the country.

The general feedback shows that healthcare practitioners have huge concerns about the proposed NHI.

“The findings indicate that there is distrust towards the government regarding the way they want to implement and manage the NHI. 80% of respondents are negative or sceptical about the NHI,” said Welthagen.

“According to the results of this report, the respondents do not believe that the NHI will succeed in improving the healthcare system and service delivery.

“Only 15% of respondents believe that it would be possible to successfully implement the NHI, and 84.5% are of the view that the implementation of the NHI could destabilise the healthcare system in South Africa and could harm the high-quality service already being provided by the private sector,” she said.

Welthagen added that the report further highlights the enormous risk that the emigration of health practitioners poses to the future of healthcare in South Africa.

“There are serious concerns about a shortage of healthcare workers, the more so in view of the fact that 20.8% of the respondents indicated that they had already taken steps to emigrate, and a further 41.06% would consider emigrating when the NHI is implemented,” Welthagen said.
2019/12/132019/12/17 08:53 AM

After months of negotiations with unions, in July the University of Cape Town (UCT) began to provide private health-care benefits to its lowest-paid workers, with a product from insurer Kaelo Health that cost a fraction of the premiums charged by medical schemes.

For the first time, a UCT employee earning as little as R10,000 a month had access to private sector primary health-care providers such as general practitioners, dentists and optometrists without paying out of pocket.
2019/12/132019/12/17 08:54 AM

Last week the Council for Medical Schemes published Circular 80 of 2019, which bans low cost benefit options.

The circular is not only contradictory and irrational, but is prejudicial to lower income individuals with health insurance products who cannot afford private medical scheme cover and do not wish to be subjected to the vagaries of a dysfunctional public healthcare sector.
2019/12/17 08:56 AM

Only three of the 11-member management team that was in place in January will remain

The medical schemes regulator has taken the shock decision to terminate the services of all but three of the senior managers reporting to its CEO, it emerged on Thursday.

The hollowing out of the Council for Medical Schemes (CMS) raises questions about its capacity to oversee the R160bn industry, which provides cover to 8.9-million people, or 15.6% of the population.
2019/12/17 09:00 AM

How could everyday South Africans hold as big a scheme as the National Health Insurance (NHI) accountable for the quality of its care?

The scheme, for which membership will be compulsory, is a state financing system that will buy healthcare services from public and private providers for the entire nation, regardless of their income. According to the current version of the NHI Bill, for which public submissions closed last week, the NHI will be fully operational by 2026.
2019/12/132019/12/17 09:02 AM

It is more than 20 years since the South African constitution first guaranteed children’s “right to basic health care services”.

This is part of a broader commitment to ensure children’s rights to optimal survival, health and development. The question is how close South Africa is to realising these rights in practice.
2019/12/132019/12/17 09:03 AM

At the root of primary healthcare is the involvement of the community and ‘this idea of social solidarity, that we need to look after those who need help the most’.

“When I was a student, it was ‘health for all’ by the year 2000,” recalled Steve Reid, a primary health care professor at the University of Cape Town. Speaking to an audience of about 30 people from the healthcare sector.
2019/12/122019/12/17 08:59 AM

One in every 31 children in South Africa will die before they reach their 5th birthday if the country fails to heed the call to put children and adolescents at the heart of the country’s healthcare system.

This emerged from the 14th annual South African Child Gauge 2019, released under the theme “Child and Adolescent Health: Leave no one behind”.
2019/12/17 09:01 AM

Residents of the OR Tambo District in the Eastern Cape were mostly in favour of the proposed National Health Insurance (NHI) Bill at a public hearing in Mthatha, but raised questions on how it would solve the Eastern Cape’s ailing health system, especially in rural areas.

Parliament’s portfolio Committee on Health held the district‘s public hearings at the Mthatha Town Hall on December 1.
2019/12/112019/12/17 08:55 AM

The medical scheme regulator’s move last week to scrap health insurance products is at odds with the constitution and will have potentially “catastrophic consequences” for consumers, warns insurer Day 1 Health CEO Richard Blackman.

The Council for Medical Schemes (CMS) issued a directive on December 4 that sent shock waves through the private health-care industry, announcing that no more exemptions to the Medical Schemes Act will be granted for entities that offer less cover than the law requires after March 2021. The circular issued by CMS registrar Sipho Kabane on December 4 means primary health and hospital insurance products, as well as bargaining council medical schemes that offer pared-down benefits, will have to be wound down by this deadline.
2019/12/102019/12/17 08:52 AM

With the announcement by the Council for Medical Schemes (CMS) that no Low-Cost Benefit Options (LCBO) will be allowed for low-income consumers and no health insurance products will be allowed beyond March 2021, South Africans are another step closer to a nationalised healthcare sector.

This is the view of think tank the Free Market Foundation (FMF), which says that the proposals are ‘shambolic’ and do not reflect a well-considered, balanced view on how to increase access to quality healthcare for low-income consumers.
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