Against the backdrop of the State’s struggles to adequately finance existing social programmes, generating new funds for the NHI are more challenging. - Dr Anja Smith, senior researcher in the economics department at Stellenbosch University, and Claire Bisseker, an economics writer and researcher at the Bureau for Economic Research.
Given the growing improbability of implementing the NHI as outlined in the 2024 NHI Act, revisiting a phased social health insurance approach may be prudent. This would necessitate the implementation of a risk-sharing or risk equalisation fund (REF) among medical schemes. Such a fund would allow schemes with a higher proportion of sicker and lower-income members to receive financial support from schemes with healthier and younger members.
To prevent further deterioration of SA’s healthcare financing infrastructure, the Competition Commission’s 2019 Health Market Inquiry (HMI) recommendations should be fully implemented These recommendations include:
• Establishing a multilateral negotiation forum to facilitate price negotiations within the private healthcare sector;
• Introducing a mandatory package of basic benefits for all medical schemes, covering at least preventive care, if not hospitalisation;
• Creating an independent regulatory body to oversee pricing, licensing, and provider behaviour to curb excessive costs and inefficiencies; and
• Mandating membership for all formally employed individuals, funded through joint employer and employee contributions.
“Time is running out, and with the existing system displaying apparent vulnerabilities and a viable NHI alternative still uncertain, it is imperative to urgently revisit and act upon previously considered proposals and innovative ideas.”