National Health Insurance (NHI) has been a hot topic for many years, and it will probably remain so as it approaches implementation, during the implementation phases and until its successful integration. Even though there are people who believe that the NHI will solve many challenges, there are also many sceptics who believe the opposite to be true. The fact of the matter is that healthcare is a basic human right in South Africa. As a country, we need a health care system that ensures that all people have access to the healthcare services they need, when and where they need them, without financial hardship.
The current dual system has created large scale inequity and poor healthcare services in the public sector which is underserviced and the private sector which is overserviced.
But who will pay for it, what will happen to our current medical aids and how will it affect the regular taxpayer who is already struggling to afford increasingly high levels of personal tax?
The funding of the NHI will be from government, however, the manner in which they will raise funds still needs to be finalised. It could be by means of different formats of taxes, i.e., raising company income tax, a surcharge on personal income tax, a special healthcare or payroll tax which could be paid by employers and employees and/or the removal of the tax credit medical schemes members currently receive.
The NHI will cover the costs of basic healthcare for all South Africans, regardless of their socio-economic status. According to the National Department of Health, this fund will work in the same way as our current medical aids do, but with two important differences:
It will cover all South Africans, employed and unemployed, high-and low-income earners. Every South African will receive the same type of healthcare, regardless of their health condition. There will be no limits set for those who are unemployed or earn a low salary.
The aim of the fund is to provide access to medical cover for everyone while, at the same time, keeping the cost of healthcare at reasonable levels and ensuring healthcare providers receive fair rates for their services. Both private and public healthcare providers will be refunded on the same basis and will be expected to provide the same standard of care.
Once the NHI covered benefits are announced, private medical schemes will not cover benefits which are covered by the NHI. It is suggested that medical scheme premiums will be for only those benefits not covered by NHI.
It has been recommended that the NHI must be gradually phased in using a progressive approach based on financial resource availability. People across the country will access health services through a primary health care (PHC) provider, either at a clinic or a general practitioner. The PHC provider will then refer people to the appropriate care. This care will be purchased from both public and private providers with the quality measured against the same standards across all accredited providers.
On 18 May 2022, parliament voted to proceed with the NHI project, but there are still several processes to go through. There are 338 891 written comments which must be deliberated (the submissions may have been destroyed in the fires at the Parliamentary buildings in Cape Town). It must go to the National Assembly (NA) and a final Whitepaper will need to be drafted and approved. This is likely to take a minimum period of five years.
It is therefore recommended that people retain their medical scheme membership in its current format.