PATRICK LUBBE: The door to affordable primary healthcare is open

Now that President Cyril Ramaphosa has signed the National Health Insurance (NHI) Bill into law, universal health coverage has edged a great deal closer for all South Africans.

This, however, does not mean that the many pressing questions and concerns of ordinary people about how this will affect their healthcare needs in the here and now are any closer to being answered.

One particular aspect of the NHI that has vexed industry pundits is its practical rollout. To date, many questions remain unanswered, with the broader healthcare and insurance industries convinced that it is still many years away from implementation. This is not least due to the lengthy list of health system-strengthening projects required before NHI can be fully realised. Moreover, enduring concern revolves around the task of securing sustainable funding for such a monumental project.

There has never been a question about the need for universal health coverage, as the National HealthCare Group and many other industry stakeholders fully concur. However, while all South Africans have the constitutional right to access healthcare, the hard truth is that SA’s public health system is not in a position to provide for everyone’s needs.

The majority of South Africans simply cannot afford to access quality healthcare at this stage and will not be able to do so for many years to come. 

So, while the government is intent on and committed to trying to fund the NHI, the roughly R1.4bn pledged by finance minister Enoch Godongwana in his national budget will not go far in getting this much-debated system off the ground in the short or medium term. In fact, estimates are that the NHI needs closer to R600bn a year to bring this mammoth initiative to fruition.

What can South Africans do over the next decade to cover their primary healthcare needs? If — heaven forbid — disaster strikes and illness or misadventure come knocking, what mechanisms are in place to ensure that the ordinary man, woman and child are not left helpless?

Unfortunately, most medical schemes, which are governed by the Council of Medical Schemes, are still prohibitively expensive for ordinary South Africans. For this reason, only about 10-million lives are covered by medical schemes. While medical schemes have long lobbied for the introduction of a low-cost benefit option in addition to their existing prescribed minimum benefits based options, this has remained a bridge too far for several reasons.

Against this backdrop, affordable healthcare insurance emerges as a pragmatic solution, offering immediate access to essential healthcare without the burden of extensive regulatory overhauls. Through innovative solutions such as TymeHealth, a collaboration between TymeBank and the National HealthCare Group, access to healthcare becomes a reality for millions more South Africans at an affordable cost.

Health insurance offerings, by virtue of their affordability and accessibility, immediately remove an unnecessary burden from the state, as members can access private medical care. These offerings already exist and can be accessed within minutes because they are typically available digitally. More importantly, they are affordable.

Broad health insurance cover does not require extensive regulatory overhauls. It’s already here, and it allows the government more time to adequately identify funding options that do not involve unaffordable tax increases on an already small tax base.

For example, TymeHealth can take care of emergency as well as day-to-day healthcare needs through a network of medical providers. Those who subscribe to these benefits have access to private healthcare and a range of critical benefits, including GP visits, acute and chronic medication, dentistry, optometry, pathology and radiology, as well as ambulance services — all at a monthly fee that starts at less than R5 a day.

The NHI has noble aims, and while changes to our healthcare structure are necessary for SA, in practice it will take time to implement. If one looks around the world at other universal healthcare systems, challenges are also evident in many other, and sometimes wealthier, countries — even before the emergence of the global pandemic of 2020.

The fact remains that unless the minister of finance increases the VAT rate by 6.5 percentage points or personal tax by 31%, which would arguably weaken the economy while subjecting South African consumers to immense hardship, especially those whom the NHI is trying to assist, we remain at a critical crossroads.

The practicalities surrounding the implementation of the NHI Act remain insurmountable, and a long, difficult road no doubt still lies ahead.

In the interim, it would appear that the government is buying time to identify a range of complex system-strengthening activities as a foundation for NHI. From building a national health information system and digital patient records, upgrading health facilities and improving quality of care to ensure that the minimum criteria are certified and accredited to the strengthening of facility and district management in preparation for contracting, this will be no simple task. Then there is the considerable undertaking of granting semi-autonomous status to central (and potentially other) hospitals and developing prices and provider payment methods for hospitals, which cannot be rushed.

As many commentators predict, it will take at least 10-15 years, if not longer, for the NHI to come into full effect. Until then, our people still need access to quality health services, and the existing option of health insurance ticks many healthcare boxes for all, making it the closest, most affordable solution to universal health coverage that we have.

Through innovative solutions and pragmatic partnerships, the quest for universal health coverage continues, one step at a time. As we navigate this healthcare odyssey, let us remember: the journey towards universal health coverage is not a solitary pursuit but a collective endeavour, with the health and wellbeing of our nation at stake.

• Lubbe is National HealthCare Group CEO.