The exclusion of medical aids from a national healthcare system after the National Health Insurance (NHI) Bill is fully implemented is a barrier to creating a workable national healthcare system that can only happen through a partnership between the private and public sectors, said financial services and medical insurance company Discovery CE and founder Adrian Gore.

Creating a workable healthcare system in South Africa requires that the public and private sector collaborate, preserve what is present and improve upon it, as well as design the system to manage the complexity of a national healthcare system.

Section 33 of the NHI Bill stipulates that private medical aids will not be permitted to provide any services that the NHI covers once implemented.

"With a few outliers, most developed and developing countries have a blend of public and private healthcare provision. We also cannot easily compare the NHI to the UK National Health Service, as it spends $3 000 a year per person, or more than ten times per person a year what South Africa does.

"Healthcare is complicated to fund in any country and our position is that we must collaborate, learn from what has worked and amplify what works. The quality of the private healthcare sector should be built up and be made a national asset that is used in the tapestry of a workable NHI," he said during the financial services and advisory firm PSG 'Think Big Series' webinar on November 7.

Further, public hospitals have areas of excellence, but also have areas of weakness and collapse, and South Africa must manage its public healthcare system better.

"Funds are scarce and management of what we have must be improved. This is one aspect of the NHI debate, and the structure of the NHI does not address the management, and healthcare must improve to ensure a return on money spent," he said.

The NHI in its current form aims to increase the funding to public healthcare from the current R250-billion a year by a further R200-billion a year, although a funding mechanism for this increase has not been proposed.

"This would raise the amount spent per patient per month from R465 to R680. However, medical aid members spend about R2 400 a month, which highlights the funding gap. Further, to fund the additional R200-billion a year would require income taxes to be raised by 30% or for value-added tax to be raised from 15% to 22%, both of which present severe challenges to the economy," Gore noted.

Additionally, in this scenario, those currently under private medical aids would see a 70% reduction in the amount spent on their healthcare each month while also seeing an increase in the taxes levied on them.

The only way to develop a workable NHI system was to keep the private sector, as more funding would be required than the limited fiscal space can provide, as well as amid the constraints in the broader economy, he said.

South Africa has nine-million people with private medical aid coverage, and the private healthcare system of 850 facilities provides healthcare to 15-million people in the country.

The ability of low- and middle-income households to afford medical aid scheme coverage, which also have prescribed minimum benefits, was a challenge, and improving access was a fundamental aim of Discovery Health and more broadly the industry, he said.

Additionally, the medical aid industry wanted the proposed low-cost benefits medical insurance products to serve as part of an integrated NHI. The industry was waiting for the Council for Medical Schemes to approve the proposals that would enable millions more to access medical aid benefits. Such products would also be needed in the meantime while the NHI was implemented over the coming decades, Gore added.

The NHI is an intergenerational piece of legislation that will take a decade or two to fully implement. However, healthcare needs investment during this period.

"We need to do more of what works and there are thousands of doctors in the public and private sectors. However, we need to ensure that people are encouraged to study and qualify as healthcare professionals and pursue careers in the industry, as the industry is not static and the sentiments in the industry can influence these, hence careful leadership during this time is needed," he highlighted.

"I want to emphasise that we need a universal healthcare coverage system in South Africa and the status quo is unsustainable. However, to achieve this means we have to create a workable NHI.

"Our country does not have the resources to afford the NHI as it is. A blended and multi-funded model, which will require the NHI, medical aid schemes and other stakeholders if appropriate to collaborate, is needed to fund universal healthcare coverage.

"In terms of Section 33, we are advocating that we continue to roll out the NHI, but that we work out a role for private medical aid schemes for once it is fully implemented," he said.

A significant concern is that the NHI Bill was adopted without any amendments despite four years of engagement with the healthcare sector, which raises questions about whether policy development takes the private sector's inputs into consideration.

"The legislation is clear, but the complexity of it makes the execution difficult. Any publicly run fund has had difficulty, because they are difficult to run. However, if the right expertise, technology and people are involved, then it can be made to work.  A public-private partnership model can work. The primary issue is affordability, but, as with the other challenges, the philosophy of collaboration will enable us to find ways to solve the funding challenge," Gore emphasised.

"The NHI is not workable without private sector collaboration. We support the policy vision as enshrined in the law, but the funding and complexity require the private sector to be involved going forward," he emphasised.