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NHI is morally correct but handle with care, says Discovery’s Adrian Gore 

Discovery CEO Adrian Gore says the proposed National Health Insurance (NHI) fund is a moral imperative for the country that he supports fully, though he warned it would require careful implementation to ensure its long-term fiscal sustainability. “A well-functioning NHI is necessary and morally correct as we need to address unacceptable levels of inequality and ensure access to quality care,” Gore told Business Day. “Discovery is supportive of the NHI and will use its capabilities and resources to assist.”

While the ANC-led government has been a vociferous supporter of the NHI, which it says is needed to create more equitable access to quality healthcare, critics argue SA cannot afford it given current fiscal debt and economic growth constraints. The Institute of Race Relations estimated in 2020 that NHI could cost the country as much as R700bn a year when it becomes operational in 2026 as the government has envisaged. That compares with SA’s total health expenditure in 2021/ 2022, which Discovery says reached R523bn, or about 9% of GDP. Of that, Discovery says about 51% was covered by private medical scheme contributions or out-of-pocket expenditure by consumers. However, given that there are only about 9-million private medical aid members in SA out of a population of 60.14-million, the vast majority of citizens are reliant on state health care.

Workable model:

Gore says Discovery presented what it believes is a workable model for a sustainable NHI to the parliamentary portfolio committee on health on January 25, which proposes an incremental blended funding model that could achieve universal health coverage in a pragmatic and sustainable way. Through this blended model, the NHI fund would be supported by tax-derived funding and also receive a mandatory contribution from citizens who are able to afford it. “A one-size-fits-all NHI would only be palatable if it provided current levels of medical scheme benefits for all — this would be extremely desirable, but unfortunately unaffordable.” The model proposed by Discovery would not permit private medical scheme members to opt out of funding the NHI, but would allow them to purchase additional cover should they wish. Gore says this would leave consumers with some degree of choice, while improving overall healthcare access for all South Africans. “There is significant risk in limiting medical schemes to offering cover only for services not reimbursable by the NHI [as set out in section 33 of the proposed NHI Bill],” said Gore. “The reality is that employed people currently utilising the private sector via medical aid schemes would only be satisfied if the NHI could deliver care that they would expect relative to what they currently receive.” Gore said it would be best to follow an incremental approach to NHI that initially sought to provide primary health care for all citizens and then gradually bulk up cover as the economy grows to provide the fiscal leeway to fund the expanded cover. He emphasised that it would be important for the public and private sector to co-operate to ensure that public health care is better resourced. “The country does have the capabilities and resources to work towards universal coverage, but this will require time and excellent leadership,” Gore said. “Our view is that private medical cover can be accommodated alongside the NHI fund as part of a social solidarity framework.

We are committed to engaging constructively with policymakers and social partners on implementable and sustainable models to achieve broad and equitable care.”