Unions welcome new healthcare laws – with a laundry list of concerns

Cape Town – South African unions and labour federations on Friday broadly welcomed the eventual release of the National Health Insurance Bill and the Medial Schemes Amendment Bill by Health Minister Aaron Motsoaledi.

But but concerns about implementation persist, particularly around what the bills mean for workers' access to quality healthcare and the state of country's health sector.

After years of work, debate and public speculation, Motsoaledi released the two bills for public comment on Thursday. He said they would transform the country's medical assistance sector, paving the way for a universal healthcare system in the future.

National Health Insurance is the state’s plan for comprehensive health services for all South African citizens and long-term residents. According to the NHI White Paper from 2017, its goal is to create a “single, publicly owned and administered strategic purchaser” that will buy healthcare services for all South Africans, from accredited public and private providers.

According to Motsoaledi, implementation of NHI will not be a once-off event, but take “a phased-in approach”. 

The Congress of South African Trade Unions (Cosatu) Parliamentary coordinator Matthew Parks told Fin24 that the final release of the bills was welcome, as development in this area had been a long time coming.

"We are quite glad that they have been released, and have been calling for this [for] a long time.

"We have been quite frustrated about this for a long time. The longer this has taken, the more we have been worried that the industry will water provisions down to save money ahead of its introduction," said Parks.

Cosatu was particularly anxious about what would happen while the bills were subject to public comment and Parliamentary processes, citing concerns over unscrupulous medical assistance providers.

The public comment period, which will last three months, will seek the views of South Africans. Thereafter, Parliament must take the bills through the legislative process – which can be lengthy – before they are ultimately enacted.

'Sitting on billions'

"The deterioration in quality of medical healthcare is of great concern, and if you look at some of the stories that have come out in recent years, it is equal to a death sentence," said Parks.

"The scrapping of accrual payments would be welcomed. The schemes and the funds sit on billions, although we do take pity with honest doctors and providers who try to give a fair deal to patients."

Parks bemoaned the delays in getting the bills out long after the cut-off time of May this year.

Failure to have the bills in Parliament by this time means they will only be realistically passed by Parliament after the 2019 election, or even as late as 2020, said Park.

Solidarity spokesperson Francois Redelinghuys told Fin24 that the union's researchers would assess the two bills "keenly", with a view to launching an awareness campaign to ensure that as many affected parties could weigh in on the draft laws as possible.

"Solidarity will, in a week’s time, launch a campaign to take a more in-depth look at the bill.

"We will be launching a campaign on this. We are concerned about this and its potential impact on the economy, medical schemes and medical practitioners, and the quality of medical care," said Redelinghuys.

The bills had to be carefully scrutinised by workers, companies, South Africa's healthcare sector and companies, Redelinghuys added, as their impact on the quality of healthcare could be significant if they were not well considered.

"There will be a lot of people who would be gravely concerned.

"Medical aid providers and practitioners will certainly be concerned, as the bills are now out for public comment," Redelinghuys said.

The Public Servants Association (PSA) welcomed aspects contained in both bills. PSA General Manager Ivan Fredericks said the "abolishment" of medical co-payments was especially welcomed, as relief for workers who struggled with monthly medical aid contributions.

'The patient shouldn't be burdened'

Presenting the two bills to the public on Thursday, Motsoaledi said the Medical Schemes Amendment Bill would mean that "every cent charged to the patient must be settled fully by the scheme and the patient should not be burdened with having to pay".

"The Minister elaborated on primary health being at the core of health care. The PSA is of the view that if more people have adequate access to primary health care, the country will be on its way to restoring human dignity," said Fredericks.

The PSA cautioned that the amendments should ensure medical-aid schemes and service providers do not have flexibility to simply adjust premiums and fees just to recover costs which come with the change to law.

The state has set aside five years from 2017 to 2022 for the development of NHI legislation and amendments to other legislation.

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