NAMAF 7th Annual Conference

Hilton Hotel, Windhoek24-25 September 2013

National Health Care Insurance [NHI] from a South African Perspective

Dr H.Z. ZokufaManaging Director : BHF

Key Issues

• Single fund and Single purchaser.• Single administrator.• National, Provincial and District outlets.• Mandatory contributions.• Comprehensive benefit package.• Both public and private healthcare providers will be

used.• The public healthcare services must be improved.• The private healthcare tariffs for healthcare services

must be regulated.• Green Paper published on 12th August 2011• We are waiting for the White Paper.

Key Issues

Role of Medical Schemes• Section 137: …accordingly, medical schemes will

continue to exist alongside NHI. However, there will be no tax subsidies for those who choose to continue with medical scheme cover.

• Section 138: The exact services that medical schemes will offer may evolve to include to-up insurance.

• Section 139: There is existing expertise residing in the health sector in the area of administration and management of insurance funds. Where necessary and relevant, this expertise may be drawn upon within the single payer publicly administered NHI, to ensure that adequate in-house capacity is developed.

Key Points

Medical Scheme Environment – possible offerings ?

• Experience, expertise and skills in the judicious management of medical scheme funds.

• Knowledge and practice of corporate governance and controls.

• Knowledge of purchasing and payment of services to providers.

• Have substantial resources that can be leveraged on.• Invested in systems and processes.• Know where the risks are.• Understand the nuances, tendencies and behavior of

members and providers.• Have built relationships with members and providers.• Can be regarded as a “mini NHI”

Challenges

For the Medical Scheme Environment

• Embrace the introduction of NHI.• Fully understand the tenets and objectives of NHI.• Find ways and means of re-aligning themselves to the

direction of NHI implementation.• Make themselves ‘relevant’ and ‘needed’.• Carry with them their membership into the NHI

environment. • Bring their expertise, experience, resources and skills into

the NHI environment. • Behave in a way that enhances the implementation of

NHI.• Be a cornerstone, anchor and pillar to government as the

foundations of NHI are constructed.• “Be an integral part of NHI”

Challenges

For the Government

• Constructive engagement.• Open dialogue.

• Regard the resources in the current Medical scheme environment as a “National asset”

• Provide leadership and direction.

• Flexibility to embark on pragmatic strategies and pathways which will achieve the same goal.

Current Environment

Medical Schemes

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Future Environment

National Health Insurance52 million lives

Medical Schemes

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Benefits

For the entire Healthcare Financing System

• The National Assets and Resources are not lost.• Successful ‘pooling’ of healthcare finances and resources.

• Most of the ‘subtle’ and ‘overt’ risks will be mitigated.

• Medical scheme members and all the South Africans, will not be subjected to unwanted turbulence, anxiety and uncertainty.

• A strong ‘building block’ of NHI would be established that will be modified in an iterative way, on an ongoing basis.