A notice published in the Government Gazette earlier this month raises constitutional concerns about the consultation process leading up to the introduction of National Health Insurance. It appears that the Minister of Health is trying to limit representation on the task team that will determine South Africa's health care future, and we call on him to reconsider these regulations.
The regulations lay out the membership of an NHI task team, which will "advise the minister on policy and legislation development and the implementation plan for the NHI system". However, the list of members specifically excludes one important interest group and creates the potential that some others, including the entire private hospital sector and medical profession, will also be excluded.
The regulations list certain interest groups which must be directly represented on the task team by somebody directly "from" those interest groups. These groups include for example nurses, organised labour, medical schemes and "the community".
However, for other important interest groups, specifically doctors, the entire private hospital care sector and the medical products industry, there is only the requirement that they be represented by someone "with knowledge and understanding of" their interests. So doctors could be represented by someone who is not a doctor, and the entire private health care sector could be represented by a health department official.
While it is possible that the minister may appoint people to these positions who come from the industries concerned, the phrasing of the requirements means that it is the minister's decision to decide who best represents these interest groups, not the groups themselves.
In addition, although medicines are a key part of the health system, there is no representative on the task team from either pharmacists or the pharmaceutical industry. Yet there is space for relatively insignificant interests, such as the military health services.
In recent history both the Traditional Health Practitioners Act and the Choice on Termination of Pregnancy Amendment Act were declared invalid. While these dealt specifically with the public comment process, the cases did entrench a requirement on the part of the government to consult properly. We call on the minister to comply with this requirement.
We are also concerned that the regulations, while laying out a detailed programme of action for the proposed task team, do not at any stage require the team to do a costing exercise. The DA believes that there are fundamental problems with the health system we have, but that we have to proceed with reforms knowing that we can afford them, and that they are sustainable.
Statement issued by Mike Waters, MP, Democratic Alliance shadow minister of health, September 25 2009
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