The Department of Health has published its revised National Health Insurance Bill, promising to bring universal health coverage to every South African.
Since being mooted, the NHI has faced constant controversy including questions around how it will be funded, which medical issues will be covered and how private medical aid users will be impacted.
These concerns have been compounded by a lack of clarity from government, and a pilot project which showed ‘mixed results’.
However, minister of Health Dr Zweli Mkhize has made it clear that his department will tackle these issues ‘as and when they appeared’, and that the NHI will be introduced ‘whether you like it or not’.
“I believe that too much discussion, analysis and diagnosis has been done and it is time for us to jump into implementation,” Mkhize said in his departmental budget speech in July.
“If we continue analysing the problem we will never end up tackling the problems.”
The revised NHI Bill published on Thursday (8 August) appears to answer at least some of the questions around the bill, including how it will be funded, what will be covered, and when the timeframe around when the NHI will be rolled out.
Who will be paying for the NHI?
While the bill is still light on some specifics around funding for the NHI, it is clear that South African taxpayers will be paying for a portion of the service.
The bill states that funding for the NHI will be collected ‘in accordance with social solidarity’ through a number of direct and indirect taxes.
These taxes include:
“Once appropriated, the revenue allocated to the fund must be paid through a budget vote to the fund as determined by agreement between the fund and the minister and subject to the provisions of the Constitution and the Public Finance Management Act,” the bill states.
The National Treasury had previously estimated that the cost of the NHI will be R256 billion, but this figure is set to change after the publication of this revised bill.
What will happen to medical aid?
Once the National Health Insurance has been fully implemented as determined by the minister through regulations in the Gazette, medical schemes may only offer complementary cover to services not reimbursable by the fund.
This echoes previous statements by Mkhize, where he said that medical aids should not cover services that fall under those covered by the NHI, and only cover those that do not.
Research published by Solidarity has previously warned that the introduction of the NHI could lead to a mass exodus of doctors from the country.
According to the report, the overall sentiment among healthcare professionals towards the NHI is generally negative, with many complaining about a lack of information around the whole scheme, and worries that the plans will completely destabilise healthcare in the country.
Who will the NHI cover?
The NHI will cover all South African citizens, permanent residents, refugees, inmates and certain groups of individual foreigners.
The bill states that asylum seekers or illegal foreigners will only be entitled to emergency medical services and services for ‘notifiable conditions of public health concern’.
All children, including children of asylum seekers or illegal migrants, will be entitled to basic health care services in line with the Constitution.
The bill states that a person seeking health care services from an accredited health care service provider or health establishment must be registered as a user of the NHI fund, and must present proof of such registration to the health care service provider or health establishment in order to secure the health care service benefits to which he or she is entitled.
The bill indicates that registration is not optional and that the above group of people must all must register as a user with the Fund at an accredited health care service provider or health establishment.
Children will be considered registered from birth.
The bill does not specify exactly what medical services will be covered, but does state that all users will ‘receive necessary quality health care services free at the point of care from an accredited health care provider or health establishment upon proof of registration with the NHI fund’.
When will the NHI be introduced?
While the bill does not appear to have a hard starting date for the introduction of the NHI, it does state that the system will be implemented in a multiphase approach.
The current timeline stated in the bill is as follows: