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robert
No to the MSA Bill
No to the NHI Bill
I wish to see South Africa with a flourishing private and state health service so that all our population will benefit.

The state is forever speaking out against monopolies but when it comes to the most important field it wants a total monopoly...how hypocritical ! Competition is always in everyone's best interests.

The state has failed hopelessly in every field, like Eskom, Transnet/Prasa, SAA, you name it, what on earth makes one think having a state run NHI will be any different. We are told that the Health Department is the most corrupt department, and has a myriad of claims against it, but the fund will strive to achieve good governance and stewardship 5.3

It speaks of cross subsidies between the affluent and the impoverished and the healthy and the sick - pure Marxist talk of an ideology that has failed world wide, even China has turned to capitalism. Instead we should be creating incentives and helping the poor to improve their lot in life. What incentive is it for the sick to strive to be healthy ? We are fast becoming an obese nation with one of the highest HIV infection rates in the world - who cares, the nanny state will provide !

There is no plan B, if the NHI fails. As we have seen all it takes is one family and virtually the whole state can be captured and brought to its knees.

2.1.3 (c) talks of a lack of sufficient qualified staff within the sector. Well if this is implemented you can be assured that there will be a flight of doctors and specialists in the medical field.
I am picking this up from speaking to those in this field. Thousands of those who are approaching or are already past retirement age are likely to call it a day. But it wont end there, thousands of high income earning citizens in all walks of life will pack up and leave our shores if they see health care collapse or deteriorate significantly.

11 (1) (k) speaks of discouraging and preventing corruption, fraud etc as if by waving a magic wand corruption and fraud which is so rife will come to an end. All indications are that it is only getting worse. Ask the Auditor General and you get figures in the billions ! When you are corrupt in the public service, you get transferred to another section or get a post as an ambassador somewhere and so things continue. When yo commit fraud in the private sector you get kicked out.

1.1.1.2(a) How on earth are you going to ensure financial protection from the costs of health care when you will have hundreds trying to get their hands in the cookie jar or board the gravy train.

We have a bureaucracy that loves loves drawing up new policies and endless plans but have a reputation worldwide of failing to implement. I am in the guesthouse business and it has taken
me four years to get Heritage Council approval for some building alterations and I am still waiting. Public servants generally don't like to make decisions or they wait for a bribe. People in the state don't understand or appreciate the private sector, all they can do is criticize and pay late.

I pray God will give those in authority the wisdom to see the folly of what we are heading into before it is too late. We love fixing things that are not broken, and leaving broken things that need fixing. In the multitude of councilors there is wisdom.. We are only going to do our countries growth rate more damage and end up turning to the IMF to bail us out on their terms.
Jacqui
No to the MSA Bill
No to the NHI Bill
Comments on the NHI Bill:

I read on 25 November that professor Jannie Rossouw and economist Mike Holland calculated that the new national health system will require R226 billion in financing by 2026. They said this could mean increases in: Income tax; Companies tax; Payroll tax; VAT. Government will need to hike taxes by an average of 10.8%.

Clause 3(3)- This override clause is overly broad. Proper analysis should be undertaken to identify and specify actual existing legislative conflicts. Clause 3(4)- the wording of this provision does not accurately reflect that actual implication of the other provisions of the Act. Provisions which may impact on the constitutionally mandated powers must be identified, and ensured that they do not commence operation until the necessary funding is available. Clause 6(o)- What mechanisms will be put in place to ensure that persons with serious existing conditions who are receiving coverage from medical schemes, will not end up not be able to obtain coverage for those conditions if they end up not being covered under the services provided under NHI, and might be refused coverage by other providers under the dramatically altered medical schemes sector (for example, if their existing medical aid no longer functions, or they decide to offer coverage for "top-up conditions" on a substantially different basis? There has been no progress in addressing the horrendous maladministration and corruption and appalling attitudes towards service delivery that are plaguing public sector facilities. There has been no confidence provided by the pilot projects that have been undertaken. These would be in contravention of requirements in clause 6. How will this be sorted out, there is absolutely no seriousness about addressing these fundamental problems. Also, if the extent of services that are covered under the NHI. Clause 7- access to services- linking a person to a single facility where they are registered is unnecessarily complex and cumbersome. It will create unnecessary rigidity and challenges when people travel or end up moving to another area. Why shouldn't a person be able to access any convenient facility where they currently happen to be when they need care, as long as they are registered on the system? The Minister at minimum must be required to prescribe how portability of services could occur, it cannot just be optional. Otherwise the system would be excessively rigid and dysfunctional. Clause 7(4)- the wording for refusal of funding for service is very concerning. Who determines that a service is not required? There are currently instances where services are refused to individuals at public faclities (ie people are sent home and refused treatment) with horrific, and sometimes fatal consequences. Such abuses must not be permitted. Similarly, it must be designated who may make the determinations of the other grounds for refusal. It must be clearly stipulated who can make this determination, and there must be an urgent appeal process available (including potentially an emergency hotline or some such immediate access to additional determination in emergency situations), to prevent the current abuses from being perpetuated. There needs to be some urgent mechanism for reconsideration in emergency circumstances, subclause (5) would not be adequate for those circumstances. If a person has already been seeing a specialist for a long period, particularly for a severe long-term condition that requires specialist support, it will be very disruptive if they had to go back and get another referral to a specialist, and if they might end up not being able to continue seeing the existing specialist who is very familiar with their case and needs. This must be catered for. Clause 8- there must be an expeditious appeal mechanism of when a condition is not medically necessary by the Benefits Advisory Committee. There must be a mechanism for inputs must be made to include treatments on the formulary, especially in relation to rare or uncommon conditions or treatments, which often are not properly considered or addressed. Chapter 3 of the Bill is extremely problematic, a new public enterprise must not be established to provide for medical funding. The record of the government in the management of public enterprises is appalling, virtually none of them are being run successfully, and to establish a state-owned enterprise to manage funding would be completely disastrous, and would ensure that the system cannot be effectively implemented. This entity would be a complete magnet for corruption and looting, and this has not been recognised or acknowledged. There has been a refusal by the National Department of Health to seriously engage with these concerns, and vague assurances that there will be proper control mechanisms in place to ensure it is properly managed are unacceptable. Having a Board accountable to the Minister is completely inadequate for the management of what would be such a massive fund, that would have the potential, if mismanaged or looted, would have the potential to bankrupt the country. The Health Department has failed to acknowledge the seriousness of these concerns, or even to accept that there is substantial corruption and maladministration in the system currently which has not been addressed at all. The model for managing the system must be seriously reconsidered and a properly strengthened model must be developed and presented before any legislation can proceed. Chapter 4- The composition of the Board must be reconsidered, there is not a sufficient requriement for financial management focus, and the Board cannot solely be accountable to the Minister of Health. There must be accountability to the Minister of Finance and to Parliament. There must be required involvement of the Minister of Finance in relation to the Management of the Fund, including the appointment of the Chief Executive Officer. The fit and proper requirements for the appointment of the Chief Executive Officer must be substantially strengthened. Clause 31- The Minister cannot be solely responsible for the financial management of the Fund. It is of significant concern that the proposed shifting of funds and functions between provincial and national spheres has not been clearly and effectively addressed, and clauses such as clause 31(2) seek to fudge the constitutional issues. Clause 33- what if there is uncertainty regarding whether a particular matter is covered by the Fund or not, or whether there is a dispute about whether the Fund or a Scheme should cover a matter? There needs to be a mechanism to obtain clarity in these matters. Clause 35(4)- if emergency fees are provided by private clinics on a capped fee basis, would patients be liable to cover any additional amount that the institution might normally charge? This must be clarified, and there needs to be mechanisms in place so that people would not end up being liable to pay additional costs for emergency services. References to manipulating or requirng payments to be made from the provincial equitable share are unacceptable, the funding matters must be addressed in the annual Division of Revenue Bill, and there must be agreement between the National Treasury and the Department as to funding matters in annual budget and Division of Revenue legislation. These matters should have been properly addressed with the National Treasury and the Provinces before this Bill was tabled in Parliament, which is completely unacceptable. There must be substantial strengthening of oversight over the offices responsible for contracting and procurement, there must be extremely rigorous oversight of these units. Clauses 37-38- Given the appalling state of current resourcing and procurement in the public health care system, government completely lacks the capacity and capability to implement such massive centralised resourcing and management, there has not been sufficient recognition by the Department of Health of the appalling state of services, or any meaningful progress in tackling the existing crisis in the public system. Adding to the scale of procurement, distribution, and management will be completely impossible for the system to achieve. There is not a need, or is it feasible, to immediately seek to completely centralised procurement and management, a much more realistic and phased in process should be developed and provided for, which initially focuses on rooting out the rot in the existing system, and then builds up the system and capacity, and the scope of functions, in a manner that is successfully achieveable and will produce substantial meaningful improvements in health care services to the vast majority of people. Adopting an approach to completely centralise all procurement and management would be disastrous. Clause 41- the process for determining fees that will be made must be much more transparent and consultative, and a process provided by which fees will be determined. Clauses 42-44- The complaints and appeals provisions are insufficiently detailed, and would not seemingly cater adequately for the full range of types of challenges that patients will experience and raise complaints in respect of. For such a massive system, there would need to be a substantial dedicated infrastructure to deal with complaints, and the Bill is completely scanty in this regard. This aspect needs substantial further development. Consideration should be given to developing an ombud scheme, and widely available complaints hotlines and mechanisms. Chapter 10, relating to financial matters, is a particularly problematic aspect of the Bill, as there is a complete lack of clarity that has been provided about how the system will be properly funded and afforded, and it is apparently expected legislation should be passed that will impose substantial obligations on government and taxpayers, without any clarity about the actual cost and how it properly will be funded. It is completely reckless and irresponsible for legislation of this magnitude and impact be proceeded with in this manner. It cannot simply be indicated that "the funding will be found" when the country is in such a perilous financial state, particualrly due to corruption and management of public enterprises. There is also a lack of clarity regarding what is happening with the provincial equitable share of health funding, and constitutional issues arise in that regard. To try and push through legislation without this fundamental aspect being properly established, is dangerous for the financial stability of the country. Transitional arrangements- the transitional arrangements are incredibly brief, and insufficient. In particular, there has been absolutely no progress in the health system strengthening initiatives, and there is no indication of seriousness in addressing the fundamental issues that are plaguing the health system, and until that fundamental rot is addressed, trying to develop a huge infrastructure and framework in the existing crumbling system, and pouring vast amounts more funding into such a crumbling system, will be a complete waste, will not result in substantial improvements in health care for the vast majority of people, which is what is desperately needed, and will put the country into further financial peril. What should be done is to make legislative reforms and implement programmes to root out the rot in the existing system, and also much better regulate private health care, to ensure that funding that is put into the existing system is effectively spent and managed and produces real improvements in health care outcomes. Then, when substantial progress has been made in that area, then a next phase of legislative reforms could be implement to more centralise aspects of the system. When those further reforms are sucessfully implemented, then a further stage of reforms can be implemented. A properly strategised, phased approach must be adopted to successfully implement a national health system. The approach of government is seeking to plunge the health and financial system into complete chaos, without proper regard for the consequences.

The government has been supposedly working on this project for years, but virtually no progress in providing the fundamental foundation that must exist for any change of the massive scale of reform that is envisaged to succeed. This is the real work which must be undertaken.
Cleo
No to the MSA Bill
No to the NHI Bill
Comments on the NHI Bill:

Wits professor Jannie Rossouw and economist Mike Holland calculated that the new national health system will require R226 billion in financing by 2026. The actual financing gap is currently R166.5 billion in 2019 – equal to 12.3% of government revenue for the year. They added that the only way to cover this shortfall would be a tax hike – both for companies and individuals. They said this could mean increases in: Income tax; Companies tax; Payroll tax; VAT. Government will need to hike taxes by an average of 10.8%. https://businesstech.co.za/news/finance/356785/massive-tax-hike-needed-to-fund-south-africas-nhi-economists/

Clause 3(3)- This override clause is overly broad, and not sufficiently carefully crafted. Such broad override clauses are contrary to good legislative drafting practice. Proper analysis should be undertaken to identify and specify actual existing legislative conflicts.

Clause 3(4)- the wording of this provision does not accurately reflect that actual implication of the other provisions of the Act. Provisions which may impact on the constitutionally mandated powers must be identified, and ensured that they do not commence operation until the necessary funding is available.

Clause 6(o)- What mechanisms will be put in place to ensure that persons with serious existing conditions who are receiving coverage from medical schemes, will not end up not be able to obtain coverage for those conditions if they end up not being covered under the services provided under NHI, and might be refused coverage by other providers under the dramatically altered medical schemes sector (for example, if their existing medical aid no longer functions, or they decide to offer coverage for "top-up conditions" on a substantially different basis?

There has been no progress in addressing the horrendous maladministration and corruption and appalling attitudes towards service delivery that are plaguing public sector facilities. There has been no confidence provided by the pilot projects that have been undertaken. These would be in contravention of requirements in clause 6. How will this be sorted out, there is absolutely no seriousness about addressing these fundamental problems. Also, if the extent of services that are covered under the NHI.

Clause 7- access to services- linking a person to a single facility where they are registered is unnecessarily complex and cumbersome. It will create unnecessary rigidity and challenges when people travel or end up moving to another area. Why shouldn't a person be able to access any convenient facility where they currently happen to be when they need care, as long as they are registered on the system? The Minister at minimum must be required to prescribe how portability of services could occur, it cannot just be optional. Otherwise the system would be excessively rigid and dysfunctional.

Clause 7(4)- the wording for refusal of funding for service is very concerning. Who determines that a service is not required? There are currently instances where services are refused to individuals at public faclities (ie people are sent home and refused treatment) with horrific, and sometimes fatal consequences. Such abuses must not be permitted. Similarly, it must be designated who may make the determinations of the other grounds for refusal. It must be clearly stipulated who can make this determination, and there must be an urgent appeal process available (including potentially an emergency hotline or some such immediate access to additional determination in emergency situations), to prevent the current abuses from being perpetuated. There needs to be some urgent mechanism for reconsideration in emergency circumstances, subclause (5) would not be adequate for those circumstances.

If a person has already been seeing a specialist for a long period, particularly for a severe long-term condition that requires specialist support, it will be very disruptive if they had to go back and get another referral to a specialist, and if they might end up not being able to continue seeing the existing specialist who is very familiar with their case and needs. This must be catered for.

Clause 8- there must be an expeditious appeal mechanism of when a condition is not medically necessary by the Benefits Advisory Committee. There must be a mechanism for inputs must be made to include treatments on the formulary, especially in relation to rare or uncommon conditions or treatments, which often are not properly considered or addressed.

Chapter 3 of the Bill is extremely problematic, a new public enterprise must not be established to provide for medical funding. The record of the government in the management of public enterprises is appalling, virtually none of them are being run successfully, and to establish a state-owned enterprise to manage funding would be completely disastrous, and would ensure that the system cannot be effectively implemented. This entity would be a complete magnet for corruption and looting, and this has not been recognised or acknowledged. There has been a refusal by the National Department of Health to seriously engage with these concerns, and vague assurances that there will be proper control mechanisms in place to ensure it is properly managed are unacceptable. Having a Board accountable to the Minister is completely inadequate for the management of what would be such a massive fund, that would have the potential, if mismanaged or looted, would have the potential to bankrupt the country. The Health Department has failed to acknowledge the seriousness of these concerns, or even to accept that there is substantial corruption and maladministration in the system currently which has not been addressed at all.

The model for managing the system must be seriously reconsidered and a properly strengthened model must be developed and presented before any legislation can proceed.

Chapter 4- The composition of the Board must be reconsidered, there is not a sufficient requriement for financial management focus, and the Board cannot solely be accountable to the Minister of Health. There must be accountability to the Minister of Finance and to Parliament.

There must be required involvement of the Minister of Finance in relation to the Management of the Fund, including the appointment of the Chief Executive Officer. The fit and proper requirements for the appointment of the Chief Executive Officer must be substantially strengthened.

Clause 31- The Minister cannot be solely responsible for the financial management of the Fund.

It is of significant concern that the proposed shifting of funds and functions between provincial and national spheres has not been clearly and effectively addressed, and clauses such as clause 31(2) seek to fudge the constitutional issues.

Clause 33- what if there is uncertainty regarding whether a particular matter is covered by the Fund or not, or whether there is a dispute about whether the Fund or a Scheme should cover a matter? There needs to be a mechanism to obtain clarity in these matters.

Clause 35(4)- if emergency fees are provided by private clinics on a capped fee basis, would patients be liable to cover any additional amount that the institution might normally charge? This must be clarified, and there needs to be mechanisms in place so that people would not end up being liable to pay additional costs for emergency services.

References to manipulating or requirng payments to be made from the provincial equitable share are unacceptable, the funding matters must be addressed in the annual Division of Revenue Bill, and there must be agreement between the National Treasury and the Department as to funding matters in annual budget and Division of Revenue legislation. These matters should have been properly addressed with the National Treasury and the Provinces before this Bill was tabled in Parliament, which is completely unacceptable.

There must be substantial strengthening of oversight over the offices responsible for contracting and procurement, there must be extremely rigorous oversight of these units.

Clauses 37-38- Given the appalling state of current resourcing and procurement in the public health care system, government completely lacks the capacity and capability to implement such massive centralised resourcing and management, there has not been sufficient recognition by the Department of Health of the appalling state of services, or any meaningful progress in tackling the existing crisis in the public system. Adding to the scale of procurement, distribution, and management will be completely impossible for the system to achieve. There is not a need, or is it feasible, to immediately seek to completely centralised procurement and management, a much more realistic and phased in process should be developed and provided for, which initially focuses on rooting out the rot in the existing system, and then builds up the system and capacity, and the scope of functions, in a manner that is successfully achieveable and will produce substantial meaningful improvements in health care services to the vast majority of people. Adopting an approach to completely centralise all procurement and management would be disastrous.

Clause 41- the process for determining fees that will be made must be much more transparent and consultative, and a process provided by which fees will be determined.

Clauses 42-44- The complaints and appeals provisions are insufficiently detailed, and would not seemingly cater adequately for the full range of types of challenges that patients will experience and raise complaints in respect of. For such a massive system, there would need to be a substantial dedicated infrastructure to deal with complaints, and the Bill is completely scanty in this regard. This aspect needs substantial further development. Consideration should be given to developing an ombud scheme, and widely available complaints hotlines and mechanisms.

Chapter 10, relating to financial matters, is a particularly problematic aspect of the Bill, as there is a complete lack of clarity that has been provided about how the system will be properly funded and afforded, and it is apparently expected legislation should be passed that will impose substantial obligations on government and taxpayers, without any clarity about the actual cost and how it properly will be funded. It is completely reckless and irresponsible for legislation of this magnitude and impact be proceeded with in this manner. It cannot simply be indicated that "the funding will be found" when the country is in such a perilous financial state, particualrly due to corruption and management of public enterprises. There is also a lack of clarity regarding what is happening with the provincial equitable share of health funding, and constitutional issues arise in that regard. To try and push through legislation without this fundamental aspect being properly established, is dangerous for the financial stability of the country.

Transitional arrangements- the transitional arrangements are incredibly brief, and insufficient. In particular, there has been absolutely no progress in the health system strengthening initiatives, and there is no indication of seriousness in addressing the fundamental issues that are plaguing the health system, and until that fundamental rot is addressed, trying to develop a huge infrastructure and framework in the existing crumbling system, and pouring vast amounts more funding into such a crumbling system, will be a complete waste, will not result in substantial improvements in health care for the vast majority of people, which is what is desperately needed, and will put the country into further financial peril. What should be done is to make legislative reforms and implement programmes to root out the rot in the existing system, and also much better regulate private health care, to ensure that funding that is put into the existing system is effectively spent and managed and produces real improvements in health care outcomes. Then, when substantial progress has been made in that area, then a next phase of legislative reforms could be implement to more centralise aspects of the system. When those further reforms are sucessfully implemented, then a further stage of reforms can be implemented.

A properly strategised, phased approach must be adopted to successfully implement a national health system. The approach of government is seeking to plunge the health and financial system into complete chaos, without proper regard for the consequences. The government has been supposedly working on this project for years, but virtually no progress in providing the fundamental foundation that must exist for any change of the massive scale of reform that is envisaged to succeed. This is the real work which must be undertaken, this legislation is relevant for a subsequent stage of the process, and is certainly premature now.
Heather
No to the MSA Bill
No to the NHI Bill
The government has not been able to successfully manage the present health care system and I do not foresee any improvement by the passing of this new bill.
Corruption has increased steadily and this will be just another avenue to steal taxpayers monies
Jeannine
Yes to the MSA Bill
No to the NHI Bill

Comments on the NHI Bill:

Clause 3(3)- This override clause is overly broad, and not sufficiently carefully crafted. Such broad override clauses are contrary to good legislative drafting practice. Proper analysis should be undertaken to identify and specify actual existing legislative conflicts.

Clause 3(4)- the wording of this provision does not accurately reflect that actual implication of the other provisions of the Act. Provisions which may impact on the constitutionally mandated powers must be identified, and ensured that they do not commence operation until the necessary funding is available.

Clause 6(o)- What mechanisms will be put in place to ensure that persons with serious existing conditions who are receiving coverage from medical schemes, will not end up not be able to obtain coverage for those conditions if they end up not being covered under the services provided under NHI, and might be refused coverage by other providers under the dramatically altered medical schemes sector (for example, if their existing medical aid no longer functions, or they decide to offer coverage for "top-up conditions" on a substantially different basis?

There has been no progress in addressing the horrendous maladministration and corruption and appalling attitudes towards service delivery that are plaguing public sector facilities. There has been no confidence provided by the pilot projects that have been undertaken. These would be in contravention of requirements in clause 6. How will this be sorted out, there is absolutely no seriousness about addressing these fundamental problems. Also, if the extent of services that are covered under the NHI.

Clause 7- access to services- linking a person to a single facility where they are registered is unnecessarily complex and cumbersome. It will create unnecessary rigidity and challenges when people travel or end up moving to another area. Why shouldn't a person be able to access any convenient facility where they currently happen to be when they need care, as long as they are registered on the system? The Minister at minimum must be required to prescribe how portability of services could occur, it cannot just be optional. Otherwise the system would be excessively rigid and dysfunctional.

Clause 7(4)- the wording for refusal of funding for service is very concerning. Who determines that a service is not required? There are currently instances where services are refused to individuals at public faclities (ie people are sent home and refused treatment) with horrific, and sometimes fatal consequences. Such abuses must not be permitted. Similarly, it must be designated who may make the determinations of the other grounds for refusal. It must be clearly stipulated who can make this determination, and there must be an urgent appeal process available (including potentially an emergency hotline or some such immediate access to additional determination in emergency situations), to prevent the current abuses from being perpetuated. There needs to be some urgent mechanism for reconsideration in emergency circumstances, subclause (5) would not be adequate for those circumstances.

If a person has already been seeing a specialist for a long period, particularly for a severe long-term condition that requires specialist support, it will be very disruptive if they had to go back and get another referral to a specialist, and if they might end up not being able to continue seeing the existing specialist who is very familiar with their case and needs. This must be catered for.

Clause 8- there must be an expeditious appeal mechanism of when a condition is not medically necessary by the Benefits Advisory Committee. There must be a mechanism for inputs must be made to include treatments on the formulary, especially in relation to rare or uncommon conditions or treatments, which often are not properly considered or addressed.

Chapter 3 of the Bill is extremely problematic, a new public enterprise must not be established to provide for medical funding. The record of the government in the management of public enterprises is appalling, virtually none of them are being run successfully, and to establish a state-owned enterprise to manage funding would be completely disastrous, and would ensure that the system cannot be effectively implemented. This entity would be a complete magnet for corruption and looting, and this has not been recognised or acknowledged. There has been a refusal by the National Department of Health to seriously engage with these concerns, and vague assurances that there will be proper control mechanisms in place to ensure it is properly managed are unacceptable. Having a Board accountable to the Minister is completely inadequate for the management of what would be such a massive fund, that would have the potential, if mismanaged or looted, would have the potential to bankrupt the country. The Health Department has failed to acknowledge the seriousness of these concerns, or even to accept that there is substantial corruption and maladministration in the system currently which has not been addressed at all.

The model for managing the system must be seriously reconsidered and a properly strengthened model must be developed and presented before any legislation can proceed.

Chapter 4- The composition of the Board must be reconsidered, there is not a sufficient requriement for financial management focus, and the Board cannot solely be accountable to the Minister of Health. There must be accountability to the Minister of Finance and to Parliament.

There must be required involvement of the Minister of Finance in relation to the Management of the Fund, including the appointment of the Chief Executive Officer. The fit and proper requirements for the appointment of the Chief Executive Officer must be substantially strengthened.

Clause 31- The Minister cannot be solely responsible for the financial management of the Fund.

It is of significant concern that the proposed shifting of funds and functions between provincial and national spheres has not been clearly and effectively addressed, and clauses such as clause 31(2) seek to fudge the constitutional issues.

Clause 33- what if there is uncertainty regarding whether a particular matter is covered by the Fund or not, or whether there is a dispute about whether the Fund or a Scheme should cover a matter? There needs to be a mechanism to obtain clarity in these matters.

Clause 35(4)- if emergency fees are provided by private clinics on a capped fee basis, would patients be liable to cover any additional amount that the institution might normally charge? This must be clarified, and there needs to be mechanisms in place so that people would not end up being liable to pay additional costs for emergency services.

References to manipulating or requirng payments to be made from the provincial equitable share are unacceptable, the funding matters must be addressed in the annual Division of Revenue Bill, and there must be agreement between the National Treasury and the Department as to funding matters in annual budget and Division of Revenue legislation. These matters should have been properly addressed with the National Treasury and the Provinces before this Bill was tabled in Parliament, which is completely unacceptable.

There must be substantial strengthening of oversight over the offices responsible for contracting and procurement, there must be extremely rigorous oversight of these units.

Clauses 37-38- Given the appalling state of current resourcing and procurement in the public health care system, government completely lacks the capacity and capability to implement such massive centralised resourcing and management, there has not been sufficient recognition by the Department of Health of the appalling state of services, or any meaningful progress in tackling the existing crisis in the public system. Adding to the scale of procurement, distribution, and management will be completely impossible for the system to achieve. There is not a need, or is it feasible, to immediately seek to completely centralised procurement and management, a much more realistic and phased in process should be developed and provided for, which initially focuses on rooting out the rot in the existing system, and then builds up the system and capacity, and the scope of functions, in a manner that is successfully achieveable and will produce substantial meaningful improvements in health care services to the vast majority of people. Adopting an approach to completely centralise all procurement and management would be disastrous.

Clause 41- the process for determining fees that will be made must be much more transparent and consultative, and a process provided by which fees will be determined.

Clauses 42-44- The complaints and appeals provisions are insufficiently detailed, and would not seemingly cater adequately for the full range of types of challenges that patients will experience and raise complaints in respect of. For such a massive system, there would need to be a substantial dedicated infrastructure to deal with complaints, and the Bill is completely scanty in this regard. This aspect needs substantial further development. Consideration should be given to developing an ombud scheme, and widely available complaints hotlines and mechanisms.

Chapter 10, relating to financial matters, is a particularly problematic aspect of the Bill, as there is a complete lack of clarity that has been provided about how the system will be properly funded and afforded, and it is apparently expected legislation should be passed that will impose substantial obligations on government and taxpayers, without any clarity about the actual cost and how it properly will be funded. It is completely reckless and irresponsible for legislation of this magnitude and impact be proceeded with in this manner. It cannot simply be indicated that "the funding will be found" when the country is in such a perilous financial state, particualrly due to corruption and management of public enterprises. There is also a lack of clarity regarding what is happening with the provincial equitable share of health funding, and constitutional issues arise in that regard. To try and push through legislation without this fundamental aspect being properly established, is dangerous for the financial stability of the country.

Transitional arrangements- the transitional arrangements are incredibly brief, and insufficient. In particular, there has been absolutely no progress in the health system strengthening initiatives, and there is no indication of seriousness in addressing the fundamental issues that are plaguing the health system, and until that fundamental rot is addressed, trying to develop a huge infrastructure and framework in the existing crumbling system, and pouring vast amounts more funding into such a crumbling system, will be a complete waste, will not result in substantial improvements in health care for the vast majority of people, which is what is desperately needed, and will put the country into further financial peril. What should be done is to make legislative reforms and implement programmes to root out the rot in the existing system, and also much better regulate private health care, to ensure that funding that is put into the existing system is effectively spent and managed and produces real improvements in health care outcomes. Then, when substantial progress has been made in that area, then a next phase of legislative reforms could be implement to more centralise aspects of the system. When those further reforms are sucessfully implemented, then a further stage of reforms can be implemented.

A properly strategised, phased approach must be adopted to successfully implement a national health system. The approach of government is seeking to plunge the health and financial system into complete chaos, without proper regard for the consequences. The government has been supposedly working on this project for years, but virtually no progress in providing the fundamental foundation that must exist for any change of the massive scale of reform that is envisaged to succeed. This is the real work which must be undertaken, this legislation is relevant for a subsequent stage of the process, and is certainly premature now.







morwapula
Yes to the MSA Bill
Yes to the NHI Bill
I fully support the NHI bill
Asanda
Yes to the MSA Bill
No to the NHI Bill
Based on the failures of the current healthcare system, I honestly do not think South Africa is ready for a comprehensive health insurance. If this is approved, it will only further weaken our already ailing healthcare system.
Liesel
Yes to the MSA Bill
Yes to the NHI Bill
Please can you ensure that the same healthcare benefits and access are given to all people who need these services whether they are South African or foreign nationals residing in South Africa.
Mariette
No to the MSA Bill
No to the NHI Bill
This will never work. If it is managed by a private institution perhaps it will work but administered by the state it will be a disaster as it is now. Just visit a casualty or a ward in a state hospital and your hair will raise!!
Elli
No to the MSA Bill
No to the NHI Bill
These proposed Bill's are in contravention of our Constitution. People will no longer have the right to choose - whether it their doctor or hospital or to simply choose to belong to a medical aid fund.

I think the sollution is that the State's Hospitals etc. should be upgraded to provide efficient health care to all, but the choice of medical aid, or to make one manditory is against our constitutional rights.
Deran
No to the MSA Bill
No to the NHI Bill
Not enough resources and this fund would be looted.

Jules
No to the MSA Bill
No to the NHI Bill
There are not enough private and public health care staff together currently for this to even be a possibility. If the government ever even wanted this to succeed they would have actually started doing the correct things years ago, for example establishing additional and dedicated colleges and universities that only specialize in the health care services as well as funding the program's and ensuring a specific number of specialists to graduate and get experience from there as well as not limiting the access of eligible students based on race and other insignificant factors. The government does not intend to see the NHI succeed they just want the money and then it will be another Eskom. Except this time people will die and their blood will be on the ANC hands. Looking at the state of the current public healthcare speaks volumes about the ability of the government to deliver any sort of quality medical services.
David
No to the MSA Bill
No to the NHI Bill
I wholeheartedly and vehemently object to the NHI Scheme as currently put forward by the ANC government. It is a clear as day that the Scheme will be a complete failure and will kill more people in its first year of implementation than it will save in its whole existence. There are no stronger terms that South Africans can use as other than complete repulsion for the crazy and near psychopathic Laws, Bills, Acts and and Schemes that are ultimately just Plots that this ANC government creates and manipulates to suck more and more money from the citizens of this great country.
I hope the NHI never sees the light of day! As hard as it must be for this government to fathom I am actually happy paying Medical Aid with the guarantee of medical assistance when I need it. The system works, don't change it!!

ANC, stop trying to own every means of production in this country! Governments have no business controlling the health of its citizens. Rather create a country-wide environment where the economy and businesses promote individual responsibility and affordability for one's own healthcare. Stop this madness before you actually start killing South Africans!
jackie
No to the MSA Bill
Yes to the NHI Bill
The NHI should be delayed until we have a better baseline service in the public sector
Debra
No to the MSA Bill
No to the NHI Bill
This is yet one more government folly, I already cross subsidise through my medical aid. not 1 government minister or municipal employee has been arrested and brought to trial for the wholesale looting of governments coffers this includes the appalling theft and corruption in the health care sector,. this is just 1 more tax to enable the government to steal I am the best person to look after my health care. Please start to be creative and think outside the box, an example is if you implemented tolls at 50c to R5 a truck a toll at the beginning you would have had pretty much 100% compliance but you had to be greedy, it may have taken a little longer to cover debt created but it would have been achievable, by implementing NHI as it is you risk losing many thousand more tax payers who are at there limits with what they pay the government for poor to no benefit and no longer have any faith in the SA government to implement anything with no corruption, a good example of this is the many South Africans who steal water and electricity or who have benefited by managing to apply for more than 1 RDP house or who move back into squatter camps and rent out RDP housing. If this final choice is taken off me I will be finally giving up on South Africa and join the milliond of tax payers who have already left
Dean
No to the MSA Bill
No to the NHI Bill
Government does not have the ability to run a universal health care system. They do not have the funds, skills nor the personnel to run a effective system. They have failed in all state owned and enterprises. What makes you think this would be any different? Government unfortunately is still filled with corrupt individuals with their own agendas which will result in this new system becoming another avenue to exploit citizens taxes benefiting only the elite . Fix the current Health system first, get rid of corruption and concentrate on growing the private sector to create jobs and boost the economy. This will ultimately help uplift the social situation we find ourselves in.
Nicolaas
No to the MSA Bill
No to the NHI Bill
What about job losses and proper health care
Jeanie
No to the MSA Bill
No to the NHI Bill
Not able to run a proper health care system now. How will the whole nation be supported
Janetta
No to the MSA Bill
No to the NHI Bill
Not able to provide health care now. How will you provide health care for a whole nation and what about job losses
Nico
No to the MSA Bill
No to the NHI Bill
Not enough funds to operate current operations
Not enough personnel
Not enough beds
Hospitals without competent personnel
bernadine
Yes to the MSA Bill
Yes to the NHI Bill
I think this is a perfect opportunity to resolve many issues like our illegal immigrant issue. Only foreigners that are registered at home affairs should be allowed on the bill. I will consider leaving the country if not as I cannot wait for medical assistance while people that dont belong here are being served. In emergency situations it is fine, assist the illegal people but then ensure the police are informed and once the illegal people are healed we send them home healthy. This way police dont have to look for the illegal people they just have to come fetch them , making their jobs alot easier this will also catch all that have fake documentation and are taking south african peoples jobs lowering xenopobhia. I also will not want to pay for peoples medical services that shouldnt be here. Thats like going to a restuarant and then someone elses food has just been added onto my bill. it is unnacceptable. Our hospitals are full of foreigners while our own people suffer and its not fair. This is an opportunity to give south africans some hope on the issue. NHI if done correctly could benefit South Africans in many ways and seeing as how South Africans have to pay for it lets ensure it benefits south africans. We cant have a shortage of medical supplies for our own people but we are giving the supplies away to people that do not in any way contribute to the south african economy. The NHI should only be used by the people that are paying for it, so drug lords that dont pay tax and are illegal in the country should not be able to register for NHI. They take all their money and send it home to their originating country, this benefits south africans in no way. We now need to stand together and look after our counrty. NHI if done correctly will help this country. We cant give people benefits they dont receive in their homelands here, this is causing the influx issue. No other country in the world does this, its only South Africa. America and Australia forces people to get sponsors which will be responsible for the individuals otherwise you are not even welcome in their countries, their peoples money (government contributions) will not assist. Lets move forward and become a first world country !!!!! Let South Africans money benefit South Africans. Those foreigners contributing to the economy and paying taxes are also welcome.
Dr BDMD
No to the MSA Bill
No to the NHI Bill
1. The NHI will bankrupt the already struggling economy.
2. The public servants can not possibly be forced to fund NHI by increase in taxation and cancelling the government 2/3 contribution towards medical scheme of your choice.
3. The NHI is another method of preferential procurement system designed to enrich the very few as it contracts services (general practitioners, suppliers, infrastructure developers.
4. The constitution stipulates that everyone has freedom of choice (to choose his/her medical aid) and freedom of association (to join either NHI or his/her medical aid of his/her choice).
asdasda
Yes to the MSA Bill
Yes to the NHI Bill
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tubidy
No to the MSA Bill
No to the NHI Bill
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asv
No to the MSA Bill
No to the NHI Bill
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