The Health Justice Initiative (HJI), a lobby group, has raised red flags over how people will access life-saving medication under the proposed National Health Insurance (NHI) Bill.

The HJI’s new study highlights several concerns, including access to critical medicine.

The National Health Insurance (NHI) is a financing system designed to pool funds to provide access to quality, affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status. The bill is being reviewed by the parliamentary portfolio committee on health clause by clause.

HJI’s  founder Fatima Hassan, said the issue had not been adequately thought through at a webinar on Monday.

“The entire shift of our medicine selection, procurement and reimbursement system to NHI reimbursement has not been adequately thought through, potentially posing a great risk for the future of medicine selection and access in the country for all people.”

Hassan said this needs ‘the attention of the highest levels of government and lawmakers, and a multi-department and stakeholder technical group is also needed to urgently determine the exact trajectory of this planned process.’

A co-author of the study, Yanga Nokhepheyi, said it was unclear how people not covered by the scheme would access basic health services.

“The NHI Bill provides that medical schemes or any other voluntary private health insurance scheme will be permitted to provide complementary health cover once NHI has been implemented. But it is unclear how people not covered by the NHI will access basic health services given proposed restrictions on medical schemes and the health care benefits they will cover once NHI is declared fully implemented,” said Nokhepheyi.

Based on their analysis of the provisions in the NHI bill, the Health Justice Initiative has raised  17 questions about transparency and transition that lawmakers and government officials should grapple with while they consider draft legislation for the finalisation and the adoption of the bill. 

Key questions on the NHI that need answers

The HJI wants the government to resolve 17 questions before implementing the NHI. Here are some of them:

  • What measures are envisaged to enable and promote public transparency related to medicine selection, procurement, and contracting processes under the NHI?
  • How will the deliberations of the NHI ministerial advisory committee be made open to the public, and how will this information be shared?
  • Not everyone living in SA will be regarded as a ‘user’ of the NHI fund. In these circumstances, will medicine manufacturers be permitted to sell medicines to health providers other than the state? If so, how will this be done, and what will be the maximum price?
  • Which medicines will automatically be covered under NHI benefits as part of the NHI formulary?
  • Which medicines will not be covered under NHI benefits as part of the NHI formulary?
  • Will wealthier people be able to bypass NHI selection and purchase more expensive life-saving and other medicines on their own/with others where the state does not procure these?
  • Many foreign migrants and South Africans without documentation will not be able to register as NHI users. How will people who are not registered NHI users be able to access basic healthcare services?
  • How will the price of medicines not included in or covered by the NHI be regulated? And what will External Reference Pricing(ERP) methodology play in the NHI and beyond?
  • When and how will the current Single Exit Price(SEP) system that governs private sector medicine acquisition be amended and/or extended, and in what phases of the implementation process will this occur? How will dispensing fees be charged, and how will section 21 exemptions be managed?

Many unanswered questions

The study also indicated that the medicine selection process in the NHI bill is complex and proposes several parallel advisory structures at times in a contradictory manner.

“The Health Justice Initiative analysed the limited provisions in the NHI bill, specifically focusing on the selection, procurement, and pricing of medicines. Because there is little information included in the NHI Bill on the exact mechanics, and there are still many unanswered questions that should not simply be left to regulations, for example, migration to a single procurement medicine system will be complex and time-consuming,” reads the study.

The Health Justice Initiative is a dedicated public health and law initiative addressing the intersection between racial and gender inequality.-Health-e News.