Many in South Africa’s private healthcare industry see the government’s plan for National Health Insurance (NHI) as a death knell to their businesses. Hermann Kohloffel, the Managing Director of NHC Medical Services, sees it as a chance to improve healthcare for all South Africans.
“No matter how you slice and dice what we see coming from NHI, how we see it as a threat or a concern, it’s an opportunity. The reason why it has to be seen as an opportunity is because healthcare has got to be available to everybody. No matter how we argue about the costs, you cannot leave somebody without care. You’re not going to leave somebody suffering with cancer and say ‘well, because you don’t have the money, we’re not going to look after you’,” he says.
Kohloffel says the reason the private health centers can turn ailing people away is because they know those patients can turn to the state for help.
“The state is ultimately the saviour of the damned and the have-nots. If this was a country that just had one system, let’s say just the private system, what would happen? You’d be forced to help that person. Nobody could in good conscience kick that person out onto the pavement… If you look at other countries’ health systems, the state is the only system. The state doesn’t turn around and say ‘because you don’t pay tax, we won’t help you’.”
South Africa’s Minister of Health, Aaron Motsoaledi, says that private healthcare is sometimes unjustifiably expensive. Kohloffel agrees and says patients often pay for expensive procedures, when a cheaper option is available and will get the same outcome.
“Healthcare continues to escalate at a cost substantially higher than inflation and usually more than the GDP of the country. This automatically causes a problem because then there’s always a deficit in the funding of healthcare. As we progress as medical professionals, the technology cost is becoming a debatable factor. If you look at an X-ray, for example, the fact that today you get a digital X-ray and you get an X-ray in 30 milliseconds, doesn’t change the outcome. The patient either has pneumonia or doesn’t,” he says.
“The cost of that care, against the quality of care that you are ultimately getting, has got to be debated… It is crippling the current private healthcare system and is the main reason why patients are buying down.”
Kohloffel refers South Africa’s current health sector as an imperfect world with an imperfect system.
“You wonder how it is possible that an appendectomy in the private health system will the cost the patient between R40,000 ($3,000) and R60,000 ($4,600). In the public system you can do an appendectomy for about R3,500 ($270). You may not survive the public hospital without scars, mental and physical, but how is that disparity even possible?”
The public and private sector needs to sit together and remember that they’re both working to achieve universal healthcare, says Kohloffel. He says the private and public health sector can learn from each other.
“What we do really well is collect money, we limit our bad debts and liabilities, pay off investments and all the rest of it. What the public sector does really well is take a miniscule budget and, despite tenderpreneurship and other interesting things that come along to try and grapple at that money, they make it last for 365 days.”
The private sector needs to try and provide solutions, rather than criticizing the NHI.
“This doesn’t happen for two reasons; first the status quo is always more comfortable, and the second thing is a lot of people see change as a threat. It’s far easier to criticize than to come up with solutions… So the private sector is not stepping forward to embrace what the government is saying needs to be achieved, and the government does not necessarily want to hear about the stumbling blocks that are in the way of achieving a political necessity as well as what’s in the best interest of creating a sustainable solution for coming generations using a collaborative approach. Currently we need accessibility to the Department of Health so we can talk solutions and not keep having doors closed because we are the private sector.”
NHC Medical Services has four health centers in the Gauteng province – in Bryanston, Honeydew, Northcliff and Centurion. It plans to open a center in Thohoyandou, in the northern Limpopo province. It also has a network of over 1,000 doctors across the country.
Kohloffel says NHC Medical Services will need to adapt once NHI is introduced. He sees it treating patients in a preventative manner.
“In winter, we all sit there like vultures hoping for the flu season to come in. The flu comes in via some Boeing from the northern hemisphere, drops the flu here, and suddenly everybody is sick and we rub our hands together because we’re making more money. Now you’ve got to change the mindset to a system where you don’t want that plane to arrive with sick tourists and, if it does, have a strategy to reduce the chances of us catching it through other preventative measures, such as flu vaccines and vitamin boosts.”
“We are going to go from being a fee-for-service providing care organization – so when you’re sick you see me, when you’re not sick, you don’t see me – to being a preventative care-based organization. We’ll have to start to look at how to screen our patients for cardiac problems, diabetes, cholesterol and all the rest of it. It’ll no longer be for patients to have an event and then we say now we need to manage your cholesterol. So, now we don’t want people to be in hospital, we want to prevent them going to hospital.”
Private healthcare will focus on areas that NHI won’t cover.
“NHI does not cover cosmetic dentistry, it will not cover breast enlargement, and so on. People will have to buy private insurance for that,” he says.
Kohloffel’s optimism over NHI doesn’t mean he is burying his head in the sand.
“I think we’re in for a big wake-up call… NHI, for us, is going to be a big challenge. Is it going to be a financial threat? Well, people have to get used to the fact that life is going to change. Life is going to change as you know it as a consumer, and as we know it as a provider of care, if this system is implemented in its current shape and form.”