NHI countdown begins

The proposed National Health Insurance (NHI) is expected to continue to be the most topical issue in the health-care industry next year as everyone is still waiting for the government to release an official document, which will hopefully shed light on the details of the plan.

Thus far, the only information in the public domain is the ANC document released at its national general council meeting in September and speculative material from various sources. The ruling party’s document is the closest thing to an official proposal.

Come January there will, theoretically, be exactly a year to go before the first phase of the NHI is implemented. It is expected to be rolled out sometime in 2012, although the month is not known yet.

Through the NHI, the government wants to introduce universal health cover for every citizen as an effort to increase access to quality health care. The plan is expected to cost R128 billion in the first year and this will rise to R325bn a year by 2025.

It will be funded through taxes and contributions by employers and employees.

The plan will offer a comprehensive package to all citizens. However, those people who wish to top up their cover with private medical aid will be allowed to do so, provided they have made their mandatory contribution to the NHI.

While the NHI will set most tongues wagging, the industry, which is constantly under fire, will have other matters to consider. Increased regulation is an issue that could dominate discussion.

The Ministry of Health is working on introducing a pricing authority, a platform that will allow service providers in the private health-care sector to discuss and negotiate prices.

The objective is to regulate pricing in the industry. At present, there is no benchmark because the reference price list was set aside by a court following an application by the Hospital Association of SA (Hasa).

From the doctors’ point of view, settling the pricing issue so that there is a standard procedure for charging patients will also be critical.

Nkaki Matlala, Hasa’s chairman, said the organisation hoped there would be a sustainable way of benchmarking prices. Hasa has always negotiated tariffs with the funders.

“We accept that might not be sustainable. You do need price benchmarking, but not price determining because you don’t want a regulator who sets pricing,” Matlala said.

Norman Mabasa, the chairman of the SA Medical Association, said it was hoped that Health Minister Aaron Motsoaledi would achieve price reductions for other drugs as he had for antiretrovirals.

“There are a few things in the public sector that are significant. We expect the revitalisation of hospitals to be a major event, we also hope that management at hospitals will be revitalised,” Mabasa said.

Matlala said another area of importance for Hasa would be the training of health-care personnel. He believed that the movement on training health-care workers was a little slow.

Discovery Health said that it would like to see the pricing issue settled.

Jonathan Broomberg, the chief executive at the medical scheme, said: “We are expecting some possible amendments to the Medical Schemes Act, as there has been talk of this for some time.”

Broomberg said Discovery also looked forward to the implementation of the Office of Standards Compliance, as this would contribute to improving quality standards throughout the health-care system.

Still on health funding, it will be interesting to see how the legal battle between the Board of Healthcare Funders (BHF) and the Council for Medical Schemes (CMS) over payment of prescribed minimum benefits (PMBs) will play out.

The BHF has approached the court seeking a declaratory order on the interpretation of the words “pay in full” found in regulation 8 of the Medical Schemes Act, which refers to the payment of PMBs.

The BHF maintains that this means paying for these conditions according to the rates of the specific scheme, while the CMS says it means reimbursing the service provider in full irrespective of the amount.

Heidi Kruger, the spokeswoman for the BHF, said there were other problems with the PMBs, such as that the definitions were not clear, they focused on hospital and specialist-based conditions and did not include primary and preventative care.

Kruger said this pushed up health-care costs. She said the PMBs were structured around specific conditions and were therefore discriminatory.

Stavros Nicolaou, the chairman of Pharmaceuticals Made in SA and senior executive of Aspen, said the industry body expected reforms to the annual price increase cycle and greater certainty on the methodology used by the pricing committee to recommend the single-exit price and the gazetting of the maximum logistics fee for public comment.

Val Beaumont, the executive director at Innovative Medicines of SA, said: “From a regulatory point of view, the establishment of a new regulatory authority (envisaged in amendments to the Medicines Act) has to be finalised in 2011.

“In addition, the establishment of a regulatory framework for medical devices, as well as complementary medicines, are imperative to protect the public as consumers of these products.” - Business Report