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NHI – what now?

25 November 2019

Dr Tony Behrman, medical business consultant at Medical Protection, takes a fresh look at the current draft NHI (National Health Insurance) Bill after his meeting with Dr Nicolas Crisp, the Government’s Chief Advisor on NHI, and shares what we know now

Welcoming the principles

The NHI Bill is currently open for public comment, permitting all stakeholders interested in the bill to come forward with comments and proposals on how the bill can be further developed. Initiatives that aim for equity in the delivery of healthcare, and more accessible and affordable healthcare for all South Africans, have been welcomed in many quarters; however, the introduction of the state scheme has also received a lot of push back from a wide range of stakeholders. Controversy over NHI will continue and opposition might grow if certain important issues, such as indemnity, remain vague or unaddressed in the bill.

Against the backdrop of a seriously overstretched public healthcare system, and increases in claims against the public sector, the new Health Minister Dr Zweli Mkhize, who has promised delivery of NHI, would be prudent to seek a more unified and all-encompassing approach.

Impact on the private sector

The NHI will remain a priority for the new government. Certain aspects of it, such as quality improvement measures, have commenced whilst selected primary healthcare services rendered by private sector providers have been prioritised to start in 2022. The full system is intended to come into effect in 2026 and proposes significant changes to the way healthcare is funded and managed.

The dynamic between private and public sector healthcare will be impacted. More private sector will be incorporated into the NHI, and the question of how these practitioners will be contracted and who will be responsible for their professional indemnity protection could arise.

Clarity over your indemnity

Unfortunately, there is still no clarity in the draft bill on where the responsibility for indemnity will lie and it is important that all healthcare practitioners seek clarification over indemnity arrangements. Likewise, the issue is clearly of importance to patients as they wish to be assured that they will continue to have access to compensation should there be clinical negligence.

If responsibility for indemnity – in cases of medical malpractice – is not clearly defined in legislation from the outset, we are concerned that this may result in risks to both patients and healthcare practitioners. Clinical negligence is a complex area of healthcare, and with our wealth of experience and knowledge in this field, we continue to express the need for indemnity arrangements being addressed in the bill. We are in close contact with government officials at the highest levels.

What is Medical Protection doing?

We are making a submission on the bill with the main aim for it to include rules around indemnity. It must be clear to Medical Protection and members about who will be responsible for compensation in cases of clinical negligence in any type of healthcare setting under the future NHI scheme, ie for NHI funded patients treated in the private sector, and NHI funded patients treated by private practitioners in the state sector. Additionally, we are interested to understand the proposed indemnity arrangements for state sector healthcare practitioners treating state patients.

For these reasons, it is vital that we liaise with the government to understand and agree on the proposed malpractice indemnity/insurance arrangements. We recently met with the Chief Advisor to the Department of Health on the bill, Dr Nicolas Crisp. Our understanding at this stage is that:

  • Doctors contracting to the NHI in the private sector would not be indemnified by the
  • State employed doctors who have a PERSAL number1 are protected by the Treasury
  • Regulations of the Public Finances Act as well as the Public Services Act.
    Private doctors would have to have their own form of indemnity or insurance.
It is crucial that there is no vacuum, and that the bill makes it explicit how indemnity cover will be arranged. We will make this clear in our parliamentary statement, which we will submit before the end of the month.

It is crucial that there is no vacuum, and that the bill makes it explicit how indemnity cover will be arranged. We will make this clear in our parliamentary statement, which we will submit before the end of the month.

We had an extremely positive first meeting with Dr Crisp. The open, frank and constructive dialogue that has now been established is something we really appreciate. We want to continue to build on, and strengthen, our existing government relationships; we continue to liaise with Dr Crisp and his team to assist with the implementation of a bill that all South Africans can support.